| NPI | 1104043017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN SERKEY Practice Administrator 860-358-4802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363A00000X Physician Assistant | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2017-01-20 |