Provider Demographics
NPI:1588047153
Name:PRINCESS CORSET & LINGERIE SHOP II, LLC
Entity type:Organization
Organization Name:PRINCESS CORSET & LINGERIE SHOP II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-755-3640
Mailing Address - Street 1:900 STRAITS TURNPIKE
Mailing Address - Street 2:SUITE 1 G
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762
Mailing Address - Country:US
Mailing Address - Phone:203-755-3640
Mailing Address - Fax:203-597-9536
Practice Address - Street 1:900 STRAITS TURNPIKE
Practice Address - Street 2:SUITE 1 G
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762
Practice Address - Country:US
Practice Address - Phone:203-755-3640
Practice Address - Fax:203-597-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies