Healthcare Provider Details

I. General information

NPI: 1376280040
Provider Name (Legal Business Name): CIVILITY MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PADANARAM RD. STE 106
DANBURY CT
06811
US

IV. Provider business mailing address

155 MAIN STREET. UNIT 307A
BREWSTER NY
10509
US

V. Phone/Fax

Practice location:
  • Phone: 203-678-0438
  • Fax: 845-278-1930
Mailing address:
  • Phone: 845-363-8523
  • Fax: 845-278-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DARYN E CLARK
Title or Position: MANAGING MEMBER
Credential:
Phone: 203-947-6086