| Organization Name: | MYSTIC GERIATRICS, LLC |
| NPI Number: | 1336167238 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUNE FLIRI (MANAGER) |
| Mailing Address: | 3 Heron Rd Mystic |
| State: | CT US |
| Postal Code: | 063553253 |
| Phone Number: | 8605365302 |
| Fax Number: | 8605365302 |
| NPI Enumeration Date: | 07/18/2006 |
| NPI Last Update Date: | 07/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |