Provider Demographics
NPI:1245331479
Name:ONE SOURCE HOMECARE SUPPLIES INC.
Entity type:Organization
Organization Name:ONE SOURCE HOMECARE SUPPLIES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYANT
Authorized Official - Middle Name:K
Authorized Official - Last Name:THAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:914-287-2410
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-0072
Mailing Address - Country:US
Mailing Address - Phone:914-287-2410
Mailing Address - Fax:914-287-2417
Practice Address - Street 1:44 E POST RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4606
Practice Address - Country:US
Practice Address - Phone:914-287-2410
Practice Address - Fax:914-287-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02703060Medicaid
NY5483290001Medicare NSC