Provider Demographics
NPI:1346545753
Name:WORLD SUPPORT SOURCE INC
Entity Type:Organization
Organization Name:WORLD SUPPORT SOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAYDZHIEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-791-3839
Mailing Address - Street 1:100 MILL PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5178
Mailing Address - Country:US
Mailing Address - Phone:203-791-3839
Mailing Address - Fax:
Practice Address - Street 1:100 MILL PLAIN RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5178
Practice Address - Country:US
Practice Address - Phone:203-791-3839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty