Provider Demographics
NPI:1013912260
Name:ALPHA MEDICAL, INC.
Entity Type:Organization
Organization Name:ALPHA MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYACHKIWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-875-2374
Mailing Address - Street 1:PO BOX 2529
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-8629
Mailing Address - Country:US
Mailing Address - Phone:860-875-2374
Mailing Address - Fax:860-870-0735
Practice Address - Street 1:635 TALCOTTVILLE RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-2319
Practice Address - Country:US
Practice Address - Phone:860-875-2374
Practice Address - Fax:860-870-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
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
0127390001Medicare NSC