Provider Demographics
NPI:1902064413
Name:PRISCILLE BELANGER
Entity Type:Organization
Organization Name:PRISCILLE BELANGER
Other - Org Name:LA CORSETERIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:207-284-8614
Mailing Address - Street 1:193 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2590
Mailing Address - Country:US
Mailing Address - Phone:207-284-8614
Mailing Address - Fax:207-284-8614
Practice Address - Street 1:193 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2590
Practice Address - Country:US
Practice Address - Phone:207-284-8614
Practice Address - Fax:207-284-8614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1065450001Medicare NSC