Provider Demographics
NPI:1457413155
Name:SUGARLESS SHOPPE, INC.
Entity Type:Organization
Organization Name:SUGARLESS SHOPPE, INC.
Other - Org Name:SUGAR CONTROL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:DME
Authorized Official - Phone:631-773-5370
Mailing Address - Street 1:306 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3507
Mailing Address - Country:US
Mailing Address - Phone:631-773-5370
Mailing Address - Fax:631-773-5369
Practice Address - Street 1:306 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3507
Practice Address - Country:US
Practice Address - Phone:631-773-5370
Practice Address - Fax:631-773-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01613083Medicaid
NY0852790001Medicare ID - Type Unspecified