Provider Demographics
NPI:1902035058
Name:INNOVA-SG CORP
Entity Type:Organization
Organization Name:INNOVA-SG CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-515-3970
Mailing Address - Street 1:800 VILLAGE WALK
Mailing Address - Street 2:#199
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2762
Mailing Address - Country:US
Mailing Address - Phone:617-515-3970
Mailing Address - Fax:203-533-5296
Practice Address - Street 1:800 VILLAGE WALK
Practice Address - Street 2:#199
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2762
Practice Address - Country:US
Practice Address - Phone:617-515-3970
Practice Address - Fax:203-533-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies