Provider Demographics
NPI:1487923926
Name:INSTACARE MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:INSTACARE MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TADD
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-444-5090
Mailing Address - Street 1:207 HALLOCK RD
Mailing Address - Street 2:STE 107
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3033
Mailing Address - Country:US
Mailing Address - Phone:888-893-6644
Mailing Address - Fax:631-444-5093
Practice Address - Street 1:207 HALLOCK RD
Practice Address - Street 2:STE 107
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3033
Practice Address - Country:US
Practice Address - Phone:888-893-6644
Practice Address - Fax:631-444-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6698870001Medicare NSC