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General NPI Number Information
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NPI Number | 1184836926
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Entity Type | Organization
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Legal Business Name | LEONARD GARY FISH
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 3 COLONIAL PLACE
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City | NEW LONDON
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State | NH
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Zip | 03257
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Country | US
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Telephone | 603-526-6990
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Fax | 603-526-6990
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Provider Business Mailing Address
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Address Line | PO BOX 970
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City | NEW LONDON
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State | NH
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Zip | 03257-0970
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Country | US
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Telephone | 603-526-6990
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Fax | 603-526-6990
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Authorized Official
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Title or Position | OPTICIAN
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Name | MRS. ELIZABETH S. FISH
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Credential |
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Telephone | 603-526-6990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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