Connetquot West, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

CONNETQUOT WEST, INC.

Practice address

200 Allen Blvd
Farmingdale, NY 11735-5637

Phone

(631) 844-0055

Fax

(631) 844-9095

NPI assigned

Sep 26, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Shirley Lam

Title

President

Phone

(631) 844-0055

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1265533079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 ALLEN BLVD",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117355637",
            "telephone_number": "631-844-0055",
            "fax_number": "631-844-9095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ALLEN BLVD",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117355637",
            "telephone_number": "631-844-0055",
            "fax_number": "631-844-9095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNETQUOT WEST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LAM",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-844-0055",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019095560002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8560803",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01426939",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Farmingdale, NY
• Providers in Farmingdale, NY by specialty
• Durable Medical Equipment & Medical Supplies in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.