Provider Demographics
NPI:1245287382
Name:PELTON'S INC.
Entity type:Organization
Organization Name:PELTON'S INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-347-7880
Mailing Address - Street 1:899 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3427
Mailing Address - Country:US
Mailing Address - Phone:860-571-6351
Mailing Address - Fax:860-571-0369
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3415
Practice Address - Country:US
Practice Address - Phone:860-346-3336
Practice Address - Fax:860-346-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
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
12DME0089CT01OtherBLUE CROSS PROVIDER NUMBE
0187100001Medicare NSC