Organization
ABILIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BARBARA MUSTAKAS (BILLING SPECIALIST)
(203) 531-1880
Entity
Organization
Contact information
Practice address
1150 SUMMER ST, STAMFORD, CT 06905-5530
(203) 324-1880
(203) 324-4390
Mailing address
50 GLENVILLE ST, GREENWICH, CT 06831-4140
(203) 324-1880
(203) 324-4390
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004186012
—
CT
Enumeration date
05/10/2007
Last updated
08/09/2022
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