Organization
VALENTINA'S INTIMATE APPAREL SHOP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN EASTON (OWNER)
(718) 667-8217
Entity
Organization
Contact information
Practice address
796 CASTLETON AVE, STATEN ISLAND, NY 10310-1800
(718) 667-8217
(718) 667-8218
Mailing address
796 CASTLETON AVE, STATEN ISLAND, NY 10310-1800
(718) 667-8217
(718) 667-8218
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01660291
—
NY
Enumeration date
01/04/2007
Last updated
02/08/2017
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