The Mortlake Fire Company of Brooklyn Connecticut Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

THE MORTLAKE FIRE COMPANY OF BROOKLYN CONNECTICUT INC

Practice address

12 Canterbury Rd
Brooklyn, CT 06234-1902

Phone

(860) 774-2032

NPI assigned

Sep 19, 2005

Organization subpart

No

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

Authorized official

Name

Lucien Brodeur

Title

Chief

Phone

(860) 774-2032

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262995200000",
    "number": "1285629964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 MAIN ST",
            "city": "CROMWELL",
            "state": "CT",
            "postal_code": "064162302",
            "telephone_number": "860-638-1800",
            "fax_number": "860-638-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 CANTERBURY RD",
            "city": "BROOKLYN",
            "state": "CT",
            "postal_code": "062341902",
            "telephone_number": "860-774-2032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MORTLAKE FIRE COMPANY OF BROOKLYN CONNECTICUT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2010-01-09",
        "status": "A",
        "authorized_official_last_name": "BRODEUR",
        "authorized_official_first_name": "LUCIEN",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "860-774-2032"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "710C019B1CT01",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004094538",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590006253",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Louise Russo, DNP, FNP-C
• Joseph A Sarkis
• Shannon Nolen Elizabeth Shannon Nolen, BCBA
• Anna Sortwell, LCSW
• The Learning Clinic, Inc.
• Joseph Toner, D.D.S.
• Hali Vaclavik, LCSW
• Brenda Lee Viens
• Village Healthcare Service LLC
• Wal-Mart Stores East LP

• All providers in Brooklyn, CT
• Land Ambulance in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.