Provider Demographics
NPI:1821091919
Name:STONEBRIGE DISTRIBUTION INC.
Entity Type:Organization
Organization Name:STONEBRIGE DISTRIBUTION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-738-9400
Mailing Address - Street 1:661 HILLSIDE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2723
Mailing Address - Country:US
Mailing Address - Phone:914-738-9400
Mailing Address - Fax:914-738-3496
Practice Address - Street 1:661 HILLSIDE RD
Practice Address - Street 2:SUITE B
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2723
Practice Address - Country:US
Practice Address - Phone:914-738-9400
Practice Address - Fax:914-738-3496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01728454Medicaid
NY01728454Medicaid