Provider Demographics
NPI:1841281045
Name:MEDI-FAIR INC
Entity type:Organization
Organization Name:MEDI-FAIR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GITLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-794-2323
Mailing Address - Street 1:25 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1161
Mailing Address - Country:US
Mailing Address - Phone:845-794-2323
Mailing Address - Fax:845-794-0712
Practice Address - Street 1:25 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1161
Practice Address - Country:US
Practice Address - Phone:845-794-2323
Practice Address - Fax:845-794-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151100OtherPK
NY01831947Medicaid
NY01831947Medicaid