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CONNECTICUT GERIATRIC SPECIALTY GROUP PC NPI 1457573933


NPI Information

NPI: 1457573933
Provider Name: CONNECTICUT GERIATRIC SPECIALTY GROUP, PC
Classification: Family Medicine - 207QG0300X
Entity Type: Organization

Specialization: Geriatric Medicine

CLIA Number: 07D2218651

Address:
1 ABRAHMS BOULEVARD
WEST HARTFORD, CT
ZIP 06117
Phone: (860) 523-3854
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CONNECTICUT GERIATRIC SPECIALTY GROUP, PC is a geriatric medicine family medicine in West Hartford, CT. The provider is a family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. CONNECTICUT GERIATRIC SPECIALTY GROUP, PC NPI is 1457573933. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1 ABRAHMS BOULEVARD
WEST HARTFORD, CT
ZIP 06117
Phone: (860) 523-3854
Fax: (860) 523-3828

The provider's authorized official is David Houle .
The authorized official title is Vice President/cfo and has the following contact phone number (860) 523-3895.

The CLIA number assigned to this NPI record is 07D2218651 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/3/2007 and was last updated on 9/4/2013.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineNo
2207RG0300XInternal MedicineGeriatric MedicineNo
3363L00000XNurse PractitionerNo
4363LA2200XNurse PractitionerAdult HealthNo
5363LG0600XNurse PractitionerGerontologyNo
6207QG0300XFamily MedicineGeriatric MedicineYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1C03907MEDICARE PINCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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