| NPI | 1073715140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELO DEFAZIO President CEO 860-570-0543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CT 01117) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: CT 01117) |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: CT 01117) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: CT 01117) | |
| 333600000X Pharmacy (Licence: CT 01117) | |
| 3336C0002X Pharmacy, Clinic Pharmacy (Licence: CT 0117) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CT 01117) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: CT 01117) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: CT 01117) | |
| 3336I0012X Pharmacy, Institutional Pharmacy (Licence: CT 01117) | |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: CT 01117) | |
| 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: CT 01117) | |
| 3336M0003X Pharmacy, Managed Care Organization Pharmacy (Licence: CT 01117) | |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: CT 01117) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: CT 01117) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-08-22 |