Healthcare Provider Details

I. General information

NPI: 1245667690
Provider Name (Legal Business Name): CONNECT MEDICAL PRODUCTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 GENESEE ST
ONEIDA NY
13421-2708
US

IV. Provider business mailing address

205 GENESEE ST
ONEIDA NY
13421-2708
US

V. Phone/Fax

Practice location:
  • Phone: 315-363-1236
  • Fax: 315-361-4884
Mailing address:
  • Phone: 315-363-1236
  • Fax: 315-361-4884

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY D GIBBONS
Title or Position: OWNER
Credential:
Phone: 315-794-2085