Provider Demographics
NPI:1992866867
Name:YANKEE MEDICAL INC
Entity Type:Organization
Organization Name:YANKEE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:FICOCIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:802-863-4591
Mailing Address - Street 1:276 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-2918
Mailing Address - Country:US
Mailing Address - Phone:802-863-4591
Mailing Address - Fax:
Practice Address - Street 1:116 BENMONT AVE
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1801
Practice Address - Country:US
Practice Address - Phone:802-442-3093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTYAV7330OtherBCBS VT
VT0007330Medicaid
MA7502028Medicaid
NH99007330Medicaid
VT1505OtherMVP
NY00358269Medicaid
VT=========OtherCOMMERCIAL INS
MA7502028Medicaid
VT0241810006Medicare ID - Type UnspecifiedMEDICARE