Provider Demographics
NPI:1700016045
Name:OXFORD DIABETIC SUPPLY, INC.
Entity Type:Organization
Organization Name:OXFORD DIABETIC SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SVITLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LETKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-391-9131
Mailing Address - Street 1:53 FRONTAGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08827-4031
Mailing Address - Country:US
Mailing Address - Phone:877-391-9131
Mailing Address - Fax:866-935-0990
Practice Address - Street 1:53 FRONTAGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-4031
Practice Address - Country:US
Practice Address - Phone:877-391-9131
Practice Address - Fax:866-935-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5442460002Medicare NSC