| NPI | 1760940035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISA PELLERIN Enrollment Specialist 860-358-4821 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2019-03-06 |