Organization
INTER LAKES MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN HAUGHNEY (CFO)
(518) 585-3700
Entity
Organization
Contact information
Practice address
1019 WICKER ST, TICONDEROGA, NY 12883-1039
(518) 585-3734
(518) 585-2334
Mailing address
1019 WICKER ST, TICONDEROGA, NY 12883-1039
(518) 585-3734
(518) 585-2334
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332B00000X
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02410819
—
NY
Enumeration date
01/16/2007
Last updated
02/08/2010
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