# NORTHEAST MEDICAL GROUP

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

## Provider details

- **NPI number:** 1396134664
- **Authorized official:** CECILIA WALDRON (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (203) 688-1734

## Contact information

- **Practice address:** 20 YORK ST, NEW HAVEN, CT 06510-3220
- **Practice address phone:** (203) 688-4242
- **Mailing address:** 226 MILL HILL AVE STE 3, BRIDGEPORT, CT 06610-2826

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 50684 | CT | Yes |

## Other

- **Enumeration date:** 01/09/2015
- **Last updated:** 01/09/2015