| NPI | 1275069353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON PERVIS Nurse Practitioner 203-628-2394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: CT 5748) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QP2300X Clinic/Center Primary Care (Licence: CT 5748) | |
| 261QP3300X Clinic/Center Pain (Licence: CT 5748) | |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2021-11-04 |