Provider Demographics
NPI:1659250082
Name:MEDIHARBOR LLC
Entity type:Organization
Organization Name:MEDIHARBOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-795-6447
Mailing Address - Street 1:1849 W WATER ST BLDG 5
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1830
Mailing Address - Country:US
Mailing Address - Phone:607-270-2777
Mailing Address - Fax:607-645-5488
Practice Address - Street 1:30 BROAD STREET 14TH FLOOR
Practice Address - Street 2:SUITE 114
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004
Practice Address - Country:US
Practice Address - Phone:607-795-6447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies