Healthcare Provider Details

I. General information

NPI: 1013912260
Provider Name (Legal Business Name): ALPHA MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 TALCOTTVILLE RD
VERNON CT
06066-2319
US

IV. Provider business mailing address

PO BOX 2529
VERNON CT
06066-8629
US

V. Phone/Fax

Practice location:
  • Phone: 860-875-2374
  • Fax: 860-870-0735
Mailing address:
  • Phone: 860-875-2374
  • Fax: 860-870-0735

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: MR. ANDREW ZAYACHKIWSKY
Title or Position: PRESIDENT
Credential:
Phone: 860-875-2374