Healthcare Provider Details

I. General information

NPI: 1679910541
Provider Name (Legal Business Name): NORWALK ACQUISITION I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PROSPECT AVE
NORWALK CT
06850-3705
US

IV. Provider business mailing address

225 CROSSWAYS PARK DR
WOODBURY NY
11797-2054
US

V. Phone/Fax

Practice location:
  • Phone: 203-853-0010
  • Fax: 203-857-4292
Mailing address:
  • Phone: 516-422-7817
  • Fax: 631-792-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PASQUALE DEBENEDICTIS
Title or Position: MEMBER
Credential:
Phone: 631-766-2126