Healthcare Provider Details

I. General information

NPI: 1598561813
Provider Name (Legal Business Name): SCOOTER A LONG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TROLLEY LINE BLVD GRAND PEQUOT COAT ROOM
MASHANTUCKET CT
06338
US

IV. Provider business mailing address

172 STODDARDS WHARF RD
GALES FERRY CT
06335-1128
US

V. Phone/Fax

Practice location:
  • Phone: 860-373-1482
  • Fax:
Mailing address:
  • Phone: 860-334-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESA V HERNANDEZ
Title or Position: OWNER
Credential:
Phone: 860-334-2744