Provider Demographics
NPI:1235319260
Name:BARE NECESSITIES OF SPRINGFIELD
Entity type:Organization
Organization Name:BARE NECESSITIES OF SPRINGFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR ACCOUNTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-643-2525
Mailing Address - Street 1:179-181 MEEKER AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114
Mailing Address - Country:US
Mailing Address - Phone:973-643-2525
Mailing Address - Fax:973-643-3539
Practice Address - Street 1:1704 BOSTON ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01129
Practice Address - Country:US
Practice Address - Phone:413-543-4642
Practice Address - Fax:413-543-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0874600001Medicare NSC