Organization Name: | ANDREW GANELES MD LLC |
NPI Number: | 1467727495 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANDREW GANELES (SOLE PRACTITIONER) |
Mailing Address: | 381 Hopmeadow St Suite 101b Weatogue |
State: | CT US |
Postal Code: | 060899692 |
Phone Number: | 8606511166 |
Fax Number: | 8606511167 |
NPI Enumeration Date: | 03/08/2012 |
NPI Last Update Date: | 03/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 035611 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |