Healthcare Provider Details

I. General information

NPI: 1497916951
Provider Name (Legal Business Name): CONNECTICUT MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 HAZARD AVE
ENFIELD CT
06082-4647
US

IV. Provider business mailing address

243 HAZARD AVE
ENFIELD CT
06082-4647
US

V. Phone/Fax

Practice location:
  • Phone: 860-749-4070
  • Fax: 860-749-0214
Mailing address:
  • Phone: 860-749-4070
  • Fax: 860-749-0241

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY DEAN SARACINO
Title or Position: VICE PRESIDENT
Credential:
Phone: 860-749-4070