Provider Demographics
NPI:1679550404
Name:DIABETES DOCTOR LLC
Entity type:Organization
Organization Name:DIABETES DOCTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:LITVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-461-0585
Mailing Address - Street 1:158 LINWOOD PLZ
Mailing Address - Street 2:STE 318
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3761
Mailing Address - Country:US
Mailing Address - Phone:201-461-0585
Mailing Address - Fax:201-461-1546
Practice Address - Street 1:158 LINWOOD PLZ
Practice Address - Street 2:STE 318
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3761
Practice Address - Country:US
Practice Address - Phone:201-461-0585
Practice Address - Fax:201-461-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5169670001Medicare ID - Type Unspecified
NJ092709Medicare PIN