Provider Demographics
NPI:1245424753
Name:ACELLERON MEDICAL PRODUCTS, INC.
Entity Type:Organization
Organization Name:ACELLERON MEDICAL PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-738-9800
Mailing Address - Street 1:28 ANDOVER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4888
Mailing Address - Country:US
Mailing Address - Phone:978-738-9800
Mailing Address - Fax:978-738-9801
Practice Address - Street 1:78 BEAVER RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2295
Practice Address - Country:US
Practice Address - Phone:860-896-5804
Practice Address - Fax:978-738-9801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACELLERON ENTERPRISES, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-29
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5426710001Medicare NSC