Provider Demographics
NPI:1831642974
Name:LOTUS MEDICAL SPECIALTIES
Entity Type:Organization
Organization Name:LOTUS MEDICAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGLIOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPED CFM
Authorized Official - Phone:860-942-9772
Mailing Address - Street 1:361 KENNEDY DR
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1636
Mailing Address - Country:US
Mailing Address - Phone:877-480-1643
Mailing Address - Fax:866-421-0813
Practice Address - Street 1:426 SALEM TPKE
Practice Address - Street 2:SUITE A
Practice Address - City:BOZRAH
Practice Address - State:CT
Practice Address - Zip Code:06334-1535
Practice Address - Country:US
Practice Address - Phone:877-480-1643
Practice Address - Fax:866-421-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies