Provider Demographics
NPI:1649303645
Name:MED-ESSENTIALS LLC
Entity type:Organization
Organization Name:MED-ESSENTIALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANBERKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-617-7392
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-0343
Mailing Address - Country:US
Mailing Address - Phone:888-617-7392
Mailing Address - Fax:203-468-9700
Practice Address - Street 1:8 WICKETT ST
Practice Address - Street 2:UNIT CC
Practice Address - City:NEW HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06057
Practice Address - Country:US
Practice Address - Phone:888-617-7392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0804471332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004251097Medicaid
CT004251097Medicaid