Provider Demographics
NPI:1821027681
Name:LIFELINE MEDICAL CORP.
Entity Type:Organization
Organization Name:LIFELINE MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLBIRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-621-2250
Mailing Address - Street 1:6821 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5856
Mailing Address - Country:US
Mailing Address - Phone:718-621-2250
Mailing Address - Fax:718-621-2250
Practice Address - Street 1:6821 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5856
Practice Address - Country:US
Practice Address - Phone:718-621-2250
Practice Address - Fax:718-621-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02513046Medicaid
NY02513046Medicaid