Provider Demographics
NPI:1235364571
Name:PROXTALKER.COM,LLC
Entity Type:Organization
Organization Name:PROXTALKER.COM,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-721-6074
Mailing Address - Street 1:327 HUNTINGDON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1413
Mailing Address - Country:US
Mailing Address - Phone:203-721-6074
Mailing Address - Fax:203-721-6070
Practice Address - Street 1:327 HUNTINGDON AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1413
Practice Address - Country:US
Practice Address - Phone:203-721-6074
Practice Address - Fax:203-721-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT45099520-001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008042594Medicaid
PA102818350 0001Medicaid
RI6710460Medicaid
ME122970024Medicaid
MI1235364571Medicaid
OH0081680Medicaid
NY03559886Medicaid
PA102818350 0001Medicaid
RI6710460Medicaid