Provider Demographics
NPI:1962512723
Name:NORTHEAST MOBILITY CENTER LTD
Entity type:Organization
Organization Name:NORTHEAST MOBILITY CENTER LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-339-2499
Mailing Address - Street 1:115 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-6417
Mailing Address - Country:US
Mailing Address - Phone:518-438-3646
Mailing Address - Fax:518-453-0919
Practice Address - Street 1:115 EVERETT RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-6417
Practice Address - Country:US
Practice Address - Phone:518-438-3646
Practice Address - Fax:518-453-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5803982OtherNCPDP PROVIDER IDENTIFICATION NUMBER