Provider Demographics
NPI:1780641522
Name:GEM RESTORATION SERVICE, INC.
Entity type:Organization
Organization Name:GEM RESTORATION SERVICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:BOCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-969-8600
Mailing Address - Street 1:179-24C UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1636
Mailing Address - Country:US
Mailing Address - Phone:718-969-8600
Mailing Address - Fax:718-969-8300
Practice Address - Street 1:179-24C UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1636
Practice Address - Country:US
Practice Address - Phone:718-969-8600
Practice Address - Fax:718-969-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00322490Medicaid
NY0138340001Medicare ID - Type UnspecifiedPROVIDER NUMBER