Provider Demographics
NPI:1063648194
Name:SERVICE SQUAD CORP
Entity type:Organization
Organization Name:SERVICE SQUAD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MOBILITY SERVICE PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-438-1599
Mailing Address - Street 1:1235 E 85TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:186-643-8159
Mailing Address - Fax:
Practice Address - Street 1:1235 E 85TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4925
Practice Address - Country:US
Practice Address - Phone:186-643-8159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies