Provider Demographics
NPI:1386948941
Name:RAY SUPPLY
Entity type:Organization
Organization Name:RAY SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:BAS
Authorized Official - Phone:518-742-0745
Mailing Address - Street 1:871 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1744
Mailing Address - Country:US
Mailing Address - Phone:518-742-0745
Mailing Address - Fax:518-792-1727
Practice Address - Street 1:871 STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1744
Practice Address - Country:US
Practice Address - Phone:518-742-0745
Practice Address - Fax:518-792-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies