Healthcare Provider Details

I. General information

NPI: 1811284300
Provider Name (Legal Business Name): SUBURBAN HOME MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 TALCOTTVILLE RD SUITE 19
VERNON CT
06066-5275
US

IV. Provider business mailing address

141 SOUTH ST
WEST HARTFORD CT
06110-1963
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-0755
  • Fax:
Mailing address:
  • Phone: 860-236-0755
  • Fax: 860-760-6777

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. GREG CZAPIGA
Title or Position: PRESIDENT
Credential:
Phone: 860-236-0755