| NPI | 1023263589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANNA D. PERERA Owner 203-937-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 036182) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 002961) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 005583) | |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2014-11-18 |