Provider Demographics
NPI:1992708283
Name:NEIGHBORHOOD DIABETES NY
Entity type:Organization
Organization Name:NEIGHBORHOOD DIABETES NY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RN-CS
Authorized Official - Phone:781-246-9302
Mailing Address - Street 1:3500 SUNRISE HIGHWAY
Mailing Address - Street 2:SUITE D116
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-3500
Mailing Address - Country:US
Mailing Address - Phone:631-961-9954
Mailing Address - Fax:631-961-9899
Practice Address - Street 1:3500 SUNRISE HIGHWAY
Practice Address - Street 2:SUITE D116
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-3500
Practice Address - Country:US
Practice Address - Phone:631-961-9954
Practice Address - Fax:631-961-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02380523Medicaid
NY4624350001Medicare ID - Type Unspecified