Provider Demographics
NPI:1366608325
Name:NISSI CORPORATION
Entity type:Organization
Organization Name:NISSI CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BUCKMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:CERT PEDORTHIST
Authorized Official - Phone:847-658-8500
Mailing Address - Street 1:782 S RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5915
Mailing Address - Country:US
Mailing Address - Phone:847-658-8500
Mailing Address - Fax:847-658-8858
Practice Address - Street 1:782 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5915
Practice Address - Country:US
Practice Address - Phone:847-658-8500
Practice Address - Fax:847-658-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies