Provider Demographics
NPI:1922034677
Name:ATLANTIC BLUE PARTNERS LLC
Entity Type:Organization
Organization Name:ATLANTIC BLUE PARTNERS LLC
Other - Org Name:VIELS' HEALTHY SOLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-643-9232
Mailing Address - Street 1:534 MIDDLE TPKE E
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3745
Mailing Address - Country:US
Mailing Address - Phone:860-643-9232
Mailing Address - Fax:860-256-4798
Practice Address - Street 1:534 MIDDLE TPKE E
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3745
Practice Address - Country:US
Practice Address - Phone:860-643-9232
Practice Address - Fax:860-256-4798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5542340001Medicare ID - Type Unspecified