NORTHEASTERN NEPHROLOGY ASSOCIATES PC NPI 1235279787

NPI Information

NORTHEASTERN NEPHROLOGY ASSOCIATES, PC is a specialist in Vernon, CT. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. NORTHEASTERN NEPHROLOGY ASSOCIATES, PC NPI is 1235279787. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

281 HARTFORD TPKE
SUITE 210
VERNON, CT
ZIP 06066-784
Phone: (860) 872-8563
Fax: (860) 870-4857

The provider's authorized official is Angelito C Bacay .
The authorized official title is President and has the following contact phone number (860) 872-8563.

The CLIA number assigned to this NPI record is 07D0092881 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/7/2007 and was last updated on 1/23/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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