| NPI | 1689491128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBENEZER ADEKUNLE KOLADE Member 203-803-7428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine |
| 207RA0401X Internal Medicine Addiction Medicine | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2024-09-25 |
| Last Update Date | 2024-09-25 |