Healthcare Provider Details

I. General information

NPI: 1588725543
Provider Name (Legal Business Name): YANKEE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MECHANIC ST
LEBANON NH
03766-1509
US

IV. Provider business mailing address

276 NORTH AVE
BURLINGTON VT
05401-2918
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-8853
  • Fax:
Mailing address:
  • Phone: 802-863-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN NICHOLAS FICOCIELLO
Title or Position: PRESIDENT
Credential: CPO
Phone: 802-863-4591