| NPI | 1053441147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE S OUELLETTE President 860-442-0290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CT 3032224000) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CT 3032224000) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2011-12-07 |