Provider Demographics
NPI:1497916951
Name:CONNECTICUT MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:CONNECTICUT MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SARACINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-749-4070
Mailing Address - Street 1:243 HAZARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4647
Mailing Address - Country:US
Mailing Address - Phone:860-749-4070
Mailing Address - Fax:860-749-0241
Practice Address - Street 1:243 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4647
Practice Address - Country:US
Practice Address - Phone:860-749-4070
Practice Address - Fax:860-749-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP008032113Medicaid