| NPI | 1033080205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AISLINN CLARE MCKEOWN Clinical Coordinator 203-543-2994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2025-09-12 |
| Last Update Date | 2025-09-12 |