# CONNECTICUT LIFESTYLE MEDICINE

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

## Provider details

- **NPI number:** 1619527959
- **Authorized official:** CATHERINE OROURKE (OWNER, NURSE)
- **Authorized official phone:** (860) 788-6573

## Contact information

- **Practice address:** 955 S MAIN ST, MIDDLETOWN, CT 06457-5153
- **Practice address phone:** (516) 993-2847
- **Mailing address:** 955 S MAIN ST \# B201, MIDDLETOWN, CT 06457-5153
- **Mailing address phone:** (860) 788-6573

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/18/2019
- **Last updated:** 08/21/2024