Provider Demographics
NPI:1306064837
Name:MAGIC CORSETS OF FOREST HILLS
Entity type:Organization
Organization Name:MAGIC CORSETS OF FOREST HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROYSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-261-6999
Mailing Address - Street 1:7010 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4763
Mailing Address - Country:US
Mailing Address - Phone:718-261-6999
Mailing Address - Fax:516-887-6788
Practice Address - Street 1:7010 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4763
Practice Address - Country:US
Practice Address - Phone:718-261-6999
Practice Address - Fax:516-887-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1067440001Medicare ID - Type Unspecified