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:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 261QM2800X | Clinic/Center | Methadone | 0230 | CONNECTICUT | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 008045323 | OTHER | CONNECTICUT | GARCIA MEDICAID |
| 2 | 001423136 | OTHER | CONNECTICUT | TETRAULT MEDICAID |
| 3 | 008037391 | OTHER | CONNECTICUT | SHACKELL MEDICAID |
| 4 | D400082725 | MEDICARE PIN | CONNECTICUT | |
| 5 | D400076510 | MEDICARE PIN | CONNECTICUT | |
| 6 | 001302497 | OTHER | CONNECTICUT | SHI MEDICAID |
| 7 | 008038053 | OTHER | CONNECTICUT | ROEHRICH MEDICAID |
| 8 | 008038052 | OTHER | CONNECTICUT | NODELMAN MEDICAID |
| 9 | 001340132 | OTHER | CONNECTICUT | SAVAGE MEDICAID |
| 10 | D400083844 | MEDICARE PIN | CONNECTICUT | |
| 11 | D400353164 | MEDICARE PIN | CONNECTICUT | |
| 12 | D400316058 | MEDICARE PIN | CONNECTICUT | |
| 13 | 008050785 | OTHER | CONNECTICUT | DROZD MEDICAID |
| 14 | D400081097 | MEDICARE PIN | CONNECTICUT | |
| 15 | D400172220 | MEDICARE PIN | CONNECTICUT | |
| 16 | 008061961 | OTHER | CONNECTICUT | SMALL-OIE MEDICAID |
| 17 | D400358415 | MEDICARE PIN | CONNECTICUT | |
| 18 | 001218107 | OTHER | CONNECTICUT | SCHOTTENFELD MEDICAID |
| 19 | 008066293 | OTHER | CONNECTICUT | MARDAM BEY MEDICAID |
| 20 | 008038037 | OTHER | CONNECTICUT | EGGERT MEDICAID |
| 21 | 110004627 | MEDICARE PIN | CONNECTICUT | |
| 22 | D400362888 | MEDICARE PIN | CONNECTICUT | |
| 23 | 008069472 | OTHER | CONNECTICUT | POTWARDOWSKI MEDICAID |
| 24 | 008003745 | OTHER | CONNECTICUT | DESROSIERS MEDICAID |
| 25 | 008053091 | OTHER | CONNECTICUT | BUTNER MEDICAID |
| 26 | 008070113 | MEDICAID | CONNECTICUT | |
| 27 | 008048393 | OTHER | CONNECTICUT | BARRY MEDICAID |
| 28 | 004082260 | OTHER | CONNECTICUT | LEGION/MEDICAID/MMT |
