Organization Name: | SOUTHEASTERN CT NEPHROLOGY ASSOC. |
NPI Number: | 1821426099 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAY M. GINSBERG (PRESIDENT) |
Mailing Address: | 88 Norwich New London Tpke Suite 2 Uncasville |
State: | CT US |
Postal Code: | 063822518 |
Phone Number: | 8603670087 |
Fax Number: | 8603670117 |
NPI Enumeration Date: | 10/24/2013 |
NPI Last Update Date: | 10/24/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 003528 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |