| NPI | 1063878734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN BAILEY Officer/Authorized Official 203-609-1168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2025-07-30 |