| NPI | 1770617367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HANNA KACKIELO Owner 860-887-0010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CT 037461) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-08-22 |