Provider Demographics
NPI:1356132914
Name:PROSPERITY MEDICAL
Entity type:Organization
Organization Name:PROSPERITY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-750-9191
Mailing Address - Street 1:206A DRYDEN RD # 916
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4724
Mailing Address - Country:US
Mailing Address - Phone:704-750-9191
Mailing Address - Fax:
Practice Address - Street 1:206A DRYDEN RD # 916
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4724
Practice Address - Country:US
Practice Address - Phone:704-750-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELIEVE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-14
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies