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Individual

ENA NANIC

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
21 SOUTH ST, RIDGEFIELD, CT 06877-4102
(516) 255-8414
Mailing address
196 MERRICK RD, OCEANSIDE, NY 11572-1420
(516) 255-8414

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
80329
CT

Other

Enumeration date
03/27/2022
Last updated
06/07/2025
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