Provider Demographics
NPI:1770551228
Name:EMPIRE HOME INFUSION SERVICE INC
Entity type:Organization
Organization Name:EMPIRE HOME INFUSION SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAZZACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-270-1310
Mailing Address - Street 1:60 COHOES AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12183-1587
Mailing Address - Country:US
Mailing Address - Phone:518-271-9600
Mailing Address - Fax:518-271-3816
Practice Address - Street 1:60 COHOES AVE
Practice Address - Street 2:
Practice Address - City:GREEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:12183-1587
Practice Address - Country:US
Practice Address - Phone:518-271-9600
Practice Address - Fax:518-271-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY44125OtherMVP
NY000478012002OtherBLUE SHIELD NENY
NY10029567OtherCDPHP
NY02164510Medicaid
NY02164510Medicaid
NY02164510Medicaid