Healthcare Provider Details

I. General information

NPI: 1124256458
Provider Name (Legal Business Name): ADVANCED MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CLIFTON AVE
ANSONIA CT
06401-2201
US

IV. Provider business mailing address

7 CLIFTON AVE
ANSONIA CT
06401
US

V. Phone/Fax

Practice location:
  • Phone: 203-736-1712
  • Fax: 203-736-1738
Mailing address:
  • Phone: 203-736-1712
  • Fax: 203-736-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN MATTHEW MARRO
Title or Position: PRESIDENT
Credential:
Phone: 203-410-2564