ACTIVE LIFE HEALTH OF NY PC (NPI# 1710445846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710445846 |
| Entity Type | Organization |
| Organization Name | ACTIVE LIFE HEALTH OF NY PC |
| Practice Address |
300 E Main St Ste 1 Smithtown NY 11787-2900 |
| Mailing Address |
Po Box 772199 Detroit MI 48277-2223 |
| Practice Telephone | 6316568796 |
| Practice Fax Number | 6313337322 |
| Mailing Telephone | 6465869333 |
| Mailing Fax Number | 6465710807 |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2019-12-04 |
| Authorized Official Name | JOHN J RUSH (CHAIRMAN & CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 3019281697 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275814105 | Active Life Health of Ny PC | General Practice | 300 E Main St Ste 1, Smithtown, NY 11787-2900 | 2011-09-06 |
| Street Address |
300 E MAIN ST STE 1 |
| City | SMITHTOWN |
| State | NY |
| Zip Code | 11787-2900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275814105 | Active Life Health of Ny PC | General Practice | 300 E Main St Ste 1, Smithtown, NY 11787-2900 | 2011-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558962779 | Gwendolyn Burris | Counselor | 20 Gilbert Avenue, Suite 107-a, Smithtown, NY 11787 | 2020-11-04 |
| 1467051193 | Karin M Caro | Adult Companion | 9 Three Pond Road, Smithtown, NY 11787 | 2020-10-23 |
| 1639706641 | Nimit Khara | Student in an Organized Health Care Education/Training Program | 240 Middle Country Rd A, Smithtown, NY 11787 | 2020-03-27 |
| 1003469032 | Maria Teresa Gardella | Nurse Practitioner | St. Catherine of Siena Medical Center, 50 Ny-25a, Smithtown, NY 11787 | 2019-07-18 |
| 1558922070 | Pamella Ann Grillo | Physician Assistant | 373 Ny-111 #5, Smithtown, NY 11787 | 2019-06-25 |
| 1306308127 | Sherry Hansen | Social Worker | 285 Middle Country Rd, Suite Ll5, Smithtown, NY 11787 | 2019-04-01 |
| 1932663747 | Kayla Roundsman | Counselor | 11 Route 11, Smithtown, NY 11787 | 2019-01-25 |
| 1568959856 | Moreen Johnson | Registered Nurse | Christian Nursing Registry, 17 Bank Ave, Smith Town, NY 11787 | 2018-04-23 |
| 1992217871 | Erica Zeller Licensed Clinical Social Work Pllc | Social Worker | 15 Bellemeade Ave Ste 3, Smithtown, NY 11787 | 2017-10-31 |
| 1881117802 | Oisin Vincent Keenan | Case Manager/Care Coordinator | 11 Ny-111, Smithtown, NY 11787 | 2017-07-21 |
| Find all providers in zip 11787 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619164811 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 712 Smithtown Byp, Smithtown, NY 11787-5004 | 2007-10-02 |
| 1487770442 | Medical Sales Consultants | Durable Medical Equipment & Medical Supplies | 9 Cresthill Pl, Smithtown, NY 11787-3703 | 2007-03-22 |
| 1154462356 | Lindroth International Inc | Durable Medical Equipment & Medical Supplies | 308 W Main St Ste 202, Smithtown, NY 11787-2617 | 2007-02-09 |
| 1528116266 | Alexa Medical Supply | Durable Medical Equipment & Medical Supplies | 308 W Main St Ste 205, Smithtown, NY 11787-2617 | 2007-01-08 |
| 1700985066 | Genovese Drug Stores Inc | Durable Medical Equipment & Medical Supplies | 65 Route 111, Smithtown, NY 11787-3712 | 2006-09-22 |
| 1104920925 | Cvs Albany LLC | Durable Medical Equipment & Medical Supplies | 111 Terry Rd, Smithtown, NY 11787-3848 | 2006-09-12 |
| 1255435004 | Cvs Albany LLC | Durable Medical Equipment & Medical Supplies | 977 W Jericho Tpke, Smithtown, NY 11787-3203 | 2006-09-12 |
| 1568498616 | Hanger Prosthetics & Orthotics East, Inc. | Durable Medical Equipment & Medical Supplies | 309 Middle Country Rd, Smithtown, NY 11787-2844 | 2006-06-23 |
| 1922474287 | Legends Medical Equipment, LLC | Durable Medical Equipment & Medical Supplies | 1056 W Jericho Tpke, Smithtown, NY 11787-3212 | 2015-08-20 |
| 1225131055 | Cvs Albany LLC | Durable Medical Equipment & Medical Supplies | 82 W Main St, Smithtown, NY 11787-2634 | 2006-09-07 |
| Find all providers in SMITHTOWN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.