Organization
RACEBROOK SHOES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK G SICSICO (PRESIDENT)
(203) 891-0772
Entity
Organization
Contact information
Practice address
554 BOSTON POST RD, SUITE 341, ORANGE, CT 06477-3341
(203) 891-0772
Mailing address
554 BOSTON POST RD, SUITE 341, ORANGE, CT 06477-3341
(203) 891-0772
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004237154
—
CT
Enumeration date
10/04/2006
Last updated
06/16/2009
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