| NPI | 1275012148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY KLASS President 203-453-1906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CT 000058) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2018-08-14 |