Healthcare Provider Details

I. General information

NPI: 1942335427
Provider Name (Legal Business Name): SUBURBAN HOME MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 SOUTH ST
WEST HARTFORD CT
06110-1963
US

IV. Provider business mailing address

141 SOUTH ST
WEST HARTFORD CT
06110-1963
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-7055
  • Fax: 860-570-1264
Mailing address:
  • Phone: 860-236-7055
  • Fax: 860-570-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL

VIII. Authorized Official

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