# OBGYN GROUP OF EASTERN CONNECTICUT, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376756908
- **Authorized official:** KELLY RICCITELLI (ADMINISTRATOR)
- **Authorized official phone:** (860) 646-1157

## Contact information

- **Practice address:** 2600 TAMARACK AVENUE, SUITE 200, SOUTH WINDSOR, CT 06074-5560
- **Practice address phone:** (860) 646-1157
- **Practice address fax:** (860) 646-9877
- **Mailing address:** 2600 TAMARACK AVENUE, SUITE 200, SOUTH WINDSOR, CT 06074-5560
- **Mailing address phone:** (860) 646-1157
- **Mailing address fax:** (860) 646-9877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/08/2007
- **Last updated:** 01/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004394251 | — | CT |