Provider Demographics
NPI:1811166564
Name:LORRAINE USTICO
Entity type:Organization
Organization Name:LORRAINE USTICO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:USTICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-824-7510
Mailing Address - Street 1:170 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-2011
Mailing Address - Country:US
Mailing Address - Phone:860-824-7510
Mailing Address - Fax:866-686-1517
Practice Address - Street 1:170 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-2011
Practice Address - Country:US
Practice Address - Phone:860-824-7510
Practice Address - Fax:866-686-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1205330001Medicare NSC