| NPI | 1891199931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER JOHNSON Administrator 203-533-9512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CT 003563) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CT 003563) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2014-10-17 |