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NPI Code Detail

MEDICARE: KEENAN RUSSELL & MOORE INC

MEDICARE: KEENAN RUSSELL & MOORE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician001177CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467510727
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEENAN RUSSELL & MOORE INC
Provider Business Mailing Address
First Line : 650 WEST AVE
Second Line :
City : NORWALK
State : CT
Zip : 06850-4020
Country : US
Telephone Number : 203-866-2775
Fax Number :
Provider Business Practice Location Address
First Line : 650 WEST AVE
Second Line :
City : NORWALK
State : CT
Zip : 06850-4020
Country : US
Telephone Number : 203-866-2775
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. JOHN JABLONSKI
Credential : LO
Telephone Number : 203-866-2775
Provider Enumeration Date : 12/05/2006
Last Update Date : 07/16/2008

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Directions to “KEENAN RUSSELL & MOORE INC ” Practice Location

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