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General NPI Number Information
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NPI Number | 1902035058
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Entity Type | Organization
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Legal Business Name | INNOVA-SG CORP
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 07/10/2009
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Provider Practice Location Address
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Address Line | 800 VILLAGE WALK #199
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City | GUILFORD
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State | CT
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Zip | 06437-2762
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Country | US
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Telephone | 617-515-3970
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Fax | 203-533-5296
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Provider Business Mailing Address
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Address Line | 800 VILLAGE WALK #199
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City | GUILFORD
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State | CT
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Zip | 06437-2762
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Country | US
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Telephone | 617-515-3970
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Fax | 203-533-5296
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. MICHAEL JOHN PECK
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Credential |
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Telephone | 617-515-3970
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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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