| NPI | 1700194636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK V DITEODORO Owner 203-323-6873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CT 035558) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: CT 035558) |
| 302R00000X Health Maintenance Organization (Licence: CT 035558) | |
| 305R00000X Preferred Provider Organization (Licence: CT 035558) | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2010-09-14 |