Provider Demographics
NPI:1598218497
Name:EMERGENCY VALPLAST LAB, LLC
Entity Type:Organization
Organization Name:EMERGENCY VALPLAST LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:203-299-1601
Mailing Address - Street 1:161 EAST AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5710
Mailing Address - Country:US
Mailing Address - Phone:203-299-1601
Mailing Address - Fax:
Practice Address - Street 1:161 EAST AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5710
Practice Address - Country:US
Practice Address - Phone:203-299-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERGENCY VALPLAST LAB, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT292200000X292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory