Organization Name: | NEW ENGLAND TELEMEDICINE PA |
NPI Number: | 1053752584 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TRUSTIN ROY ENNACHERIL (PRESIDENT/CEO) |
Mailing Address: | 98 Route 236 Suite 2 Kittery |
State: | ME US |
Postal Code: | 039045527 |
Phone Number: | 8552750464 |
Fax Number: | 2077032780 |
NPI Enumeration Date: | 07/12/2013 |
NPI Last Update Date: | 10/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |