Provider Demographics
NPI:1376280040
Name:CIVILITY MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:CIVILITY MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-947-6086
Mailing Address - Street 1:155 MAIN STREET.
Mailing Address - Street 2:UNIT 307A
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509
Mailing Address - Country:US
Mailing Address - Phone:845-363-8523
Mailing Address - Fax:845-278-1930
Practice Address - Street 1:1 PADANARAM RD.
Practice Address - Street 2:STE 106
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811
Practice Address - Country:US
Practice Address - Phone:203-678-0438
Practice Address - Fax:845-278-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies