1598908857 NPI number — CUSTOM LATEX SLEEP PRODUCTS, LLC

Table of content: MARY MILLER KROHN RN (NPI 1679022438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598908857 NPI number — CUSTOM LATEX SLEEP PRODUCTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUSTOM LATEX SLEEP PRODUCTS, 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:
Provider Other Organization Name Type Code:
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:
1598908857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06484-4508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-567-4884
Provider Business Mailing Address Fax Number:
203-567-4886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06484-4508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-567-4884
Provider Business Practice Location Address Fax Number:
203-567-4886
Provider Enumeration Date:
04/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ZUKOWSKI
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
203-567-4884

Provider Taxonomy Codes

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

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





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