Provider Demographics
NPI:1871781047
Name:PRIMED, LLC
Entity type:Organization
Organization Name:PRIMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PRIMED, LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-944-1940
Mailing Address - Street 1:3 ENTERPRISE DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4694
Mailing Address - Country:US
Mailing Address - Phone:203-944-1940
Mailing Address - Fax:203-402-4196
Practice Address - Street 1:501 KINGS HWY E
Practice Address - Street 2:SUITE 204
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4867
Practice Address - Country:US
Practice Address - Phone:203-610-6300
Practice Address - Fax:203-610-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02041OtherMEDICARE GROUP #