Provider Demographics
NPI:1588725543
Name:YANKEE MEDICAL INC
Entity type:Organization
Organization Name:YANKEE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:FICOCIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:802-863-4591
Mailing Address - Street 1:276 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-2918
Mailing Address - Country:US
Mailing Address - Phone:802-863-4591
Mailing Address - Fax:
Practice Address - Street 1:165 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1509
Practice Address - Country:US
Practice Address - Phone:603-448-8853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00358269Medicaid
NH99007330Medicaid
VT0007330OtherBCBS VT
VT1505OtherMVP
NH1200915YONH01OtherNH BCBS
VT0007330Medicaid
VT0007330Medicaid
NY00358269Medicaid