Healthcare Provider Details

I. General information

NPI: 1205961877
Provider Name (Legal Business Name): GRAEBER' MEDICAL AND NUTRI SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 WEST MAIN ST
MERIDEN CT
06451-4104
US

IV. Provider business mailing address

172 E WEST MAIN ST
MERIDEN CT
06451-4104
US

V. Phone/Fax

Practice location:
  • Phone: 203-235-6305
  • Fax: 203-235-0244
Mailing address:
  • Phone: 203-235-0132
  • Fax: 203-235-0244

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: ROGER C DEZINNO
Title or Position: MEMBER
Credential:
Phone: 203-235-6305