Organization
THE MORTLAKE FIRE COMPANY OF BROOKLYN CONNECTICUT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCIEN BRODEUR (CHIEF)
(860) 774-2032
Entity
Organization
Contact information
Practice address
12 CANTERBURY RD, BROOKLYN, CT 06234-1902
(860) 774-2032
Mailing address
269 MAIN ST, CROMWELL, CT 06416-2302
(860) 638-1800
(860) 638-1802
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004094538
—
CT
01
—
590006253
RAILROAD MEDICARE
—
01
—
710C019B1CT01
BLUE CROSS/BLUE SHIELD
—
Enumeration date
09/19/2005
Last updated
01/09/2010
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