Provider Demographics
NPI:1932455730
Name:LIFE INFUSIONS CORP
Entity Type:Organization
Organization Name:LIFE INFUSIONS CORP
Other - Org Name:LIFE INFUSIONS CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-575-2231
Mailing Address - Street 1:1500 ASTOR AVE FL 2B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5900
Mailing Address - Country:US
Mailing Address - Phone:347-533-6000
Mailing Address - Fax:347-533-7000
Practice Address - Street 1:1500 ASTOR AVE FL 2B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5900
Practice Address - Country:US
Practice Address - Phone:347-533-6000
Practice Address - Fax:347-533-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336H0001X, 3336M0003X
NY0313793336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5805645OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY7082760001Medicare NSC