Provider Demographics
NPI:1841629094
Name:GARY PRODUCTS
Entity type:Organization
Organization Name:GARY PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:FRAGIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:862-754-5875
Mailing Address - Street 1:19 ANDROS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 ANDROS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2003
Practice Address - Country:US
Practice Address - Phone:800-879-0527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility