Provider Demographics
NPI:1649213927
Name:NORTHERN NY INFUS
Entity Type:Organization
Organization Name:NORTHERN NY INFUS
Other - Org Name:OPTIONCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-785-5436
Mailing Address - Street 1:PO BOX 6369
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-6369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21093 NYS RTE 12F
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1078
Practice Address - Country:US
Practice Address - Phone:315-788-3527
Practice Address - Fax:315-788-3527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023382333600000X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01776109Medicaid
3336446OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3336446OtherOTHER ID NUMBER-COMMERCIAL NUMBER