Provider Demographics
NPI:1073745709
Name:INNOVATIVE MEDICAL THERAPIES, INC.
Entity Type:Organization
Organization Name:INNOVATIVE MEDICAL THERAPIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-633-5263
Mailing Address - Street 1:212 NEW LONDON TPKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4202
Mailing Address - Country:US
Mailing Address - Phone:860-633-5263
Mailing Address - Fax:516-931-6348
Practice Address - Street 1:600 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3453
Practice Address - Country:US
Practice Address - Phone:516-931-6300
Practice Address - Fax:516-931-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies