Provider Demographics
NPI:1366881344
Name:ICON HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:ICON HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:OBINNA
Authorized Official - Last Name:ENU
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:917-686-3432
Mailing Address - Street 1:360 CONNECTICUT AVE
Mailing Address - Street 2:#124
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1824
Mailing Address - Country:US
Mailing Address - Phone:800-243-8370
Mailing Address - Fax:888-374-0626
Practice Address - Street 1:9 GLENWOOD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-1504
Practice Address - Country:US
Practice Address - Phone:800-243-8370
Practice Address - Fax:888-374-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies