Organization Name: | FAMILY MEDICINE PARTERSHIP |
NPI Number: | 1992132161 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RONALD BUCKMAN (OWNER) |
Mailing Address: | 921 Boston Tpke Ste A Bolton |
State: | CT US |
Postal Code: | 060437403 |
Phone Number: | 8606460649 |
Fax Number: | 8606491995 |
NPI Enumeration Date: | 10/03/2013 |
NPI Last Update Date: | 10/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 5515 |
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: |