Provider Demographics
NPI:1558459834
Name:LORRAINE SOUTHWORTH DBA NEW BEGINNINGS HEALTH CARE
Entity type:Organization
Organization Name:LORRAINE SOUTHWORTH DBA NEW BEGINNINGS HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FITTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOUTHWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:REGMASECTOMYFITTER
Authorized Official - Phone:315-634-1295
Mailing Address - Street 1:104 VANIDA DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1618
Mailing Address - Country:US
Mailing Address - Phone:315-487-2779
Mailing Address - Fax:315-487-0461
Practice Address - Street 1:5008 BRITTONFIELD PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9248
Practice Address - Country:US
Practice Address - Phone:315-634-1295
Practice Address - Fax:315-634-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1322830002Medicare ID - Type UnspecifiedEAST SYRACUSE LOCATION
NY1322830002Medicare NSC