Provider Demographics
NPI:1992750913
Name:INNOVATIVE SERVICES INC
Entity type:Organization
Organization Name:INNOVATIVE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, CIO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-853-1280
Mailing Address - Street 1:7506 STATE ROUTE 5
Mailing Address - Street 2:PO BOX 325
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-3654
Mailing Address - Country:US
Mailing Address - Phone:315-853-1280
Mailing Address - Fax:315-853-1285
Practice Address - Street 1:200 AIRPARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5716
Practice Address - Country:US
Practice Address - Phone:585-328-2050
Practice Address - Fax:585-394-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 251J00000X, 332BP3500X, 332BX2000X, 3336S0011X
NY028984333600000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY28984OtherPHARMACY LICENSE
NYAAHDOtherMCD ETIN
NY3358771OtherNCPDP
NY6853OtherMCD PIN
NY02985142Medicaid
NY0701L003OtherDOH LICENSE
NY0701L003OtherDOH LICENSE
NY02985142Medicaid