Provider Demographics
NPI:1962627497
Name:A & E MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:A & E MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-589-5400
Mailing Address - Street 1:152 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6043
Mailing Address - Country:US
Mailing Address - Phone:860-589-5400
Mailing Address - Fax:
Practice Address - Street 1:152 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6043
Practice Address - Country:US
Practice Address - Phone:860-589-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
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
CT5589270001Medicare ID - Type Unspecified