Provider Demographics
NPI:1598705386
Name:EMPIRE HOME INFUSION SERVICE INC
Entity Type:Organization
Organization Name:EMPIRE HOME INFUSION SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAZZACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-270-1310
Mailing Address - Street 1:10 BLACKSMITH DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4428
Mailing Address - Country:US
Mailing Address - Phone:518-899-8103
Mailing Address - Fax:518-899-2968
Practice Address - Street 1:10 BLACKSMITH DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4428
Practice Address - Country:US
Practice Address - Phone:518-899-8103
Practice Address - Fax:518-899-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00042512001OtherUNIVERA
NY38242OtherGHI
NY040401000497OtherFIDELIS
NYB1A15OtherEMPIRE BC
NY000388OtherEMPIRE BC FACILITY
NY3317028OtherEPIC
NY10029567OtherCDPHP
NYCWW311OtherEMPHC-DME
NYY060817OtherCHAMPUS
NY000478012001OtherBSNENY, SR BLUE
NY01697465Medicaid
NY07794179OtherGATEWAY
NY991638OtherMVP
NY991638OtherMVP
NY000388OtherEMPIRE BC FACILITY
NY040401000497OtherFIDELIS
NY=========OtherORVIS
NY3317028Medicare ID - Type UnspecifiedMEDICARE PART D
NY01697465Medicaid