Provider Demographics
NPI:1598561813
Name:SCOOTER A LONG, LLC
Entity type:Organization
Organization Name:SCOOTER A LONG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:V
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-334-2744
Mailing Address - Street 1:172 STODDARDS WHARF RD
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1128
Mailing Address - Country:US
Mailing Address - Phone:860-334-2744
Mailing Address - Fax:
Practice Address - Street 1:350 TROLLEY LINE BLVD
Practice Address - Street 2:GRAND PEQUOT COAT ROOM
Practice Address - City:MASHANTUCKET
Practice Address - State:CT
Practice Address - Zip Code:06338
Practice Address - Country:US
Practice Address - Phone:860-373-1482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies