Healthcare Provider Details

I. General information

NPI: 1912655309
Provider Name (Legal Business Name): ARIDI MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 STERLING RD
MOOSUP CT
06354-2039
US

IV. Provider business mailing address

56 STERLING RD
MOOSUP CT
06354-2039
US

V. Phone/Fax

Practice location:
  • Phone: 917-283-8288
  • Fax:
Mailing address:
  • Phone: 917-283-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ADE ARIDI-RUSSELL
Title or Position: MANAGING OWNER
Credential:
Phone: 917-283-8288