Provider Demographics
NPI:1982457461
Name:LIFEVAC LLC
Entity Type:Organization
Organization Name:LIFEVAC LLC
Other - Org Name:LIFEVAC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-560-2438
Mailing Address - Street 1:120 LAKE AVE S # 35
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1060
Mailing Address - Country:US
Mailing Address - Phone:877-543-3822
Mailing Address - Fax:
Practice Address - Street 1:120 LAKE AVE S # 35
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1060
Practice Address - Country:US
Practice Address - Phone:877-543-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment