| NPI | 1114269032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMENICK JOHN MASIELLO Owner 203-826-3582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 000278) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CT 000278) |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2013-03-18 |