| NPI | 1588132625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNE LESICZKA Credentialing Coordinator 860-358-4811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363A00000X Physician Assistant | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2018-11-09 |