Provider Demographics
NPI:1720080948
Name:MEDIDYNE CORP
Entity Type:Organization
Organization Name:MEDIDYNE CORP
Other - Org Name:MEDIDYNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:UHLENBURG
Authorized Official - Last Name:L.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-882-4567
Mailing Address - Street 1:80 LITTLE FALLS RD
Mailing Address - Street 2:STE 5
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2136
Mailing Address - Country:US
Mailing Address - Phone:973-882-4567
Mailing Address - Fax:973-882-3637
Practice Address - Street 1:80 LITTLE FALLS RD
Practice Address - Street 2:STE 5
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2136
Practice Address - Country:US
Practice Address - Phone:973-882-4567
Practice Address - Fax:973-882-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG6627OtherEMPIRE BLUE CROSS
CA1520683OtherUNITED MINE WORKERS
CT3097955Medicaid
PA01629632 0004Medicaid
NY01628697Medicaid
MD5526019000Medicaid
NJ8046301Medicaid
TX80-00026OtherEVERCARE
DE0000888816Medicaid
VA608653OtherBLUE CROSS BLUE SHIELD
VA608653OtherBLUE CROSS BLUE SHIELD