Organization
OPTUM INFUSION SERVICES 100, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID OBERG (VP, COMPLIANCE)
(499) 988-5893
Entity
Organization
Contact information
Practice address
931 D CONKLIN STREET, FARMINGDALE, NY 11735
(800) 346-6348
(866) 689-3569
Mailing address
931 D CONKLIN STREET, FARMINGDALE, NY 11735
(800) 346-6348
(866) 689-3569
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
9296L0001
NY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
020477
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114382
AETNA
NY
01
—
58658
VYTRA
NY
01
—
85329
MVP
NY
01
—
9296L001
HOME CARE SERVICE AGENCY LICENSE
NY
01
—
ANC1772
OXFORD
NY
01
—
B6A532
EMPIRE BC/BS
NY
Enumeration date
04/20/2006
Last updated
09/22/2021
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