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General NPI Number Information
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NPI Number | 1972870657
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Entity Type | Organization
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Legal Business Name | DORAL ENTERPRISES
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 375 WALNUT STREET EXT
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City | AGAWAM
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State | MA
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Zip | 01001-1547
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Country | US
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Telephone | 413-789-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 9 KINGFISHER LN
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City | SUFFIELD
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State | CT
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Zip | 06078-1548
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALBERT VICEDOMINI
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Credential |
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Telephone | 504-236-5437
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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 | MA
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