Provider Demographics
NPI:1316264039
Name:DIABETES CARE-ON-THE-GO
Entity type:Organization
Organization Name:DIABETES CARE-ON-THE-GO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-257-2344
Mailing Address - Street 1:8721 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3609
Mailing Address - Country:US
Mailing Address - Phone:718-257-2344
Mailing Address - Fax:718-257-2364
Practice Address - Street 1:8721 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3609
Practice Address - Country:US
Practice Address - Phone:718-257-2344
Practice Address - Fax:718-257-2364
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERARD DRUGS,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02207243Medicaid
NY4537350001Medicare NSC