Provider Demographics
NPI:1780810820
Name:CDMI LLC
Entity type:Organization
Organization Name:CDMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REED
Authorized Official - Middle Name:
Authorized Official - Last Name:CYPRIANO
Authorized Official - Suffix:
Authorized Official - Credentials:CERT COMPR THEART
Authorized Official - Phone:860-415-4532
Mailing Address - Street 1:14 MASONS ISLAND RD
Mailing Address - Street 2:SUITE 14C - BOX 15
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2958
Mailing Address - Country:US
Mailing Address - Phone:860-415-4534
Mailing Address - Fax:888-476-0283
Practice Address - Street 1:14 MASONS ISLAND RD
Practice Address - Street 2:SUITE 14C - BOX 15
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2958
Practice Address - Country:US
Practice Address - Phone:860-415-4534
Practice Address - Fax:888-476-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTAPPLICATION IN PROCE261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric