Provider Demographics
NPI:1972741825
Name:SUNNYSIDE RESPIRATORY CARE INC
Entity type:Organization
Organization Name:SUNNYSIDE RESPIRATORY CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-488-4450
Mailing Address - Street 1:9045 LAFONTANA BLVD
Mailing Address - Street 2:206
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5636
Mailing Address - Country:US
Mailing Address - Phone:561-488-4450
Mailing Address - Fax:561-488-4451
Practice Address - Street 1:9045 LAFONTANA BLVD
Practice Address - Street 2:206
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-5636
Practice Address - Country:US
Practice Address - Phone:561-488-4450
Practice Address - Fax:561-488-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13133103336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1041968OtherNCPDP PROVIDER IDENTIFICATION NUMBER