Provider Demographics
NPI:1902052657
Name:DIABETIC SUPPLY CENTER
Entity Type:Organization
Organization Name:DIABETIC SUPPLY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NANDOR
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HERNADI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:313-478-3268
Mailing Address - Street 1:21500 HARPER AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2211
Mailing Address - Country:US
Mailing Address - Phone:586-350-0623
Mailing Address - Fax:888-712-7443
Practice Address - Street 1:21500 HARPER AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2211
Practice Address - Country:US
Practice Address - Phone:586-350-0623
Practice Address - Fax:888-712-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies