| NPI | 1205361052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN BAILEY Officer/Authorized Official 203-609-1168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2024-09-05 |