| NPI | 1255851481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK DITEODORO Manager 203-912-7807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: CT 4729) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2018-02-28 |