| NPI | 1336279058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN MARTIN VP Finance 860-358-3005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 023007) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine |
| 207R00000X Internal Medicine (Licence: CT 023007) | |
| 363A00000X Physician Assistant (Licence: CT 000621) | |
| 363LF0000X Nurse Practitioner Family (Licence: CT 002921) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2021-05-03 |