Provider Demographics
NPI:1780182527
Name:INDEPENDENT FORMULA INC.
Entity Type:Organization
Organization Name:INDEPENDENT FORMULA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-801-4331
Mailing Address - Street 1:558 E 181ST ST APT 10L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-1658
Mailing Address - Country:US
Mailing Address - Phone:718-801-4331
Mailing Address - Fax:
Practice Address - Street 1:558 E 181ST ST APT 10L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1658
Practice Address - Country:US
Practice Address - Phone:718-801-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies