| NPI | 1750592564 |
|---|---|
| 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 1698) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: CT 1698) |
| 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: CT 1698) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies (Licence: CT 1698) | |
| 333600000X Pharmacy (Licence: CT 1698) | |
| 3336C0002X Pharmacy Clinic Pharmacy (Licence: CT 1698) | |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: CT 1698) | |
| 3336C0004X Pharmacy Compounding Pharmacy (Licence: CT 1698) | |
| 3336H0001X Pharmacy Home Infusion Therapy Pharmacy (Licence: CT 1698) | |
| 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: CT 1698) | |
| 3336M0002X Pharmacy Mail Order Pharmacy (Licence: CT 1698) | |
| 3336M0003X Pharmacy Managed Care Organization Pharmacy (Licence: CT 1698) | |
| 3336S0011X Pharmacy Specialty Pharmacy (Licence: CT 1698) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: CT 1698) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |