| NPI | 1003005703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIZELLE FLORES Credentialing Manager 860-944-4766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2025-02-11 |