| NPI | 1124905559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE JEAN RAVECH Chief Managed Care Officer 860-305-6640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2025-08-18 |
| Last Update Date | 2025-08-18 |