Provider Demographics
NPI:1902956832
Name:AGING WITH ATTITUDE MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:AGING WITH ATTITUDE MEDICAL SUPPLIES, INC.
Other - Org Name:AWA MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-791-9383
Mailing Address - Street 1:272 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6624
Mailing Address - Country:US
Mailing Address - Phone:203-791-9383
Mailing Address - Fax:
Practice Address - Street 1:272 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6624
Practice Address - Country:US
Practice Address - Phone:203-791-9383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2700524-001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00424683200Medicaid
CT12DME0837CT01OtherANTHEM BLUE CROSS
NY02689389Medicaid
CT278914OtherPREFERRED ONE WELL CARE
CT5194840001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER