Provider Demographics
NPI:1013169408
Name:UNITED DIABETIC SUPPLIES
Entity Type:Organization
Organization Name:UNITED DIABETIC SUPPLIES
Other - Org Name:A&R MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-349-6800
Mailing Address - Street 1:PO BOX 7272
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-7272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 NORTHPOINT PKWY STE 300
Practice Address - Street 2:
Practice Address - City:W. PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1953
Practice Address - Country:US
Practice Address - Phone:855-349-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0924777332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122925OtherPK
6170950001Medicare NSC