Provider Demographics
NPI:1992270599
Name:VANGUARD MEDICAL LLC
Entity type:Organization
Organization Name:VANGUARD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-808-6532
Mailing Address - Street 1:24 SODOM LN STE 1
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2608
Mailing Address - Country:US
Mailing Address - Phone:860-808-6532
Mailing Address - Fax:
Practice Address - Street 1:1 PARROTT DR STE 400
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4853
Practice Address - Country:US
Practice Address - Phone:860-808-6532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies