Provider Demographics
NPI:1215193164
Name:A FITTING EXPERIENCE LLC
Entity Type:Organization
Organization Name:A FITTING EXPERIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RADIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-398-2639
Mailing Address - Street 1:5600 POST RD
Mailing Address - Street 2:
Mailing Address - City:E GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3400
Mailing Address - Country:US
Mailing Address - Phone:401-398-2639
Mailing Address - Fax:401-398-2659
Practice Address - Street 1:5600 POST RD
Practice Address - Street 2:
Practice Address - City:E GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3400
Practice Address - Country:US
Practice Address - Phone:401-398-2639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2920001Medicaid
RI2920001Medicaid