MEDICARE: CLINTON MARKETS LLC

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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1497304067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON MARKETS LLC

Provider Business Mailing Address
First Line	:	PO BOX 15169
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07192-5169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	266 E MAIN ST
Second Line	:
City	:	CLINTON
State	:	CT
Zip	:	06413-2254
Country	:	US
Telephone Number	:	860-669-6619
Fax Number	:

Authorized Official
Title or Position	:	THIRD PARTY ADMINISTRATOR
Name	:	MELISSA FIGUEROA RIVERA
Credential	:
Telephone Number	:	732-521-8439

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	09/06/2019

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Directions to “CLINTON MARKETS LLC ” Practice Location

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