Basic Information
| Provider Information | |||||||||
| NPI: | 1255997334 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CTUC01 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MILL PLAIN RD | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068115178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609866440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 672 SILAS DEANE HWY | ||||||||
| Address2: | |||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061093053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609673600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2019 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | LOVALLO | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8609866440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.