Provider Demographics
NPI:1770687485
Name:NORTHEAST MEDICAL PRODUCTS, INC.
Entity Type:Organization
Organization Name:NORTHEAST MEDICAL PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DROBIARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-388-1437
Mailing Address - Street 1:520 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1539
Mailing Address - Country:US
Mailing Address - Phone:860-388-1437
Mailing Address - Fax:
Practice Address - Street 1:520 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1539
Practice Address - Country:US
Practice Address - Phone:860-388-1437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT253487001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004067062Medicaid
CT004067062Medicaid