Provider Demographics
NPI:1912032269
Name:MERIDEN SURGICAL SUPPLY INC
Entity Type:Organization
Organization Name:MERIDEN SURGICAL SUPPLY INC
Other - Org Name:MERIDEN SURGICAL SUPPLY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEZINNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-235-6305
Mailing Address - Street 1:172 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-4104
Mailing Address - Country:US
Mailing Address - Phone:203-235-6305
Mailing Address - Fax:203-235-0244
Practice Address - Street 1:172 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-4104
Practice Address - Country:US
Practice Address - Phone:203-235-6305
Practice Address - Fax:203-235-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition