Provider Demographics
NPI:1922351287
Name:NEW LIFE VAN, AUTO AND TRUCK MODIFICATION
Entity Type:Organization
Organization Name:NEW LIFE VAN, AUTO AND TRUCK MODIFICATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-361-1244
Mailing Address - Street 1:258 VAN KEUREN AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-6603
Mailing Address - Country:US
Mailing Address - Phone:845-361-1244
Mailing Address - Fax:
Practice Address - Street 1:971 STATE ROUTE 42
Practice Address - Street 2:
Practice Address - City:SPARROW BUSH
Practice Address - State:NY
Practice Address - Zip Code:12780-5014
Practice Address - Country:US
Practice Address - Phone:845-361-1244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LIVE VAN, AUTO AND TRUCK MODIFICATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies