| NPI | 1982021812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAN TEDESCO Insurance Coordinator 203-869-1145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 3067) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2014-03-28 |