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General NPI Number Information
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NPI Number | 1598561813
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Entity Type | Organization
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Legal Business Name | SCOOTER A LONG, LLC
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 350 TROLLEY LINE BLVD GRAND PEQUOT COAT ROOM
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City | MASHANTUCKET
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State | CT
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Zip | 06338
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Country | US
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Telephone | 860-373-1482
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Fax |
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Provider Business Mailing Address
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Address Line | 172 STODDARDS WHARF RD
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City | GALES FERRY
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State | CT
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Zip | 06335-1128
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Country | US
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Telephone | 860-334-2744
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. THERESA V HERNANDEZ
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Credential |
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Telephone | 860-334-2744
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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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