Provider Demographics
NPI:1942549902
Name:GREMLIN HOME MEDICAL EQUIPMENT & SUPPLIES, LLC
Entity Type:Organization
Organization Name:GREMLIN HOME MEDICAL EQUIPMENT & SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-794-2085
Mailing Address - Street 1:15 SENECA AVE
Mailing Address - Street 2:STATE RT 5
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2555
Mailing Address - Country:US
Mailing Address - Phone:315-363-1236
Mailing Address - Fax:315-361-4884
Practice Address - Street 1:15 SENECA AVE
Practice Address - Street 2:STATE RT 5
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2555
Practice Address - Country:US
Practice Address - Phone:315-363-1236
Practice Address - Fax:315-361-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition