Healthcare Provider Details

I. General information

NPI: 1003145525
Provider Name (Legal Business Name): SUBURBAN HOME MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S MAIN ST
COLCHESTER CT
06415-1456
US

IV. Provider business mailing address

141 SOUTH ST
WEST HARTFORD CT
06110-1963
US

V. Phone/Fax

Practice location:
  • Phone: 860-537-3436
  • Fax:
Mailing address:
  • Phone: 860-236-0755
  • Fax: 860-570-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GREG CZAPIGA
Title or Position: PRESIDENT / OWNER
Credential:
Phone: 860-899-3700