1619924149 NPI number — M&M INDUSTRIES LLC

Table of content: (NPI 1619924149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619924149 NPI number — M&M INDUSTRIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M&M INDUSTRIES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
A2Z HOME MEDICAL SUPPLIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619924149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
162 LAKEWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH GLASTONBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06073-2319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-430-1079
Provider Business Mailing Address Fax Number:
860-430-1079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 CHESTERFIELD RD
Provider Second Line Business Practice Location Address:
FLANDERS PLAZA
Provider Business Practice Location Address City Name:
EAST LYME
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06333-1249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-739-1316
Provider Business Practice Location Address Fax Number:
860-739-1320
Provider Enumeration Date:
05/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANFREDI
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
860-430-1079

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004251980 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com