Organization
AVON MEDICAL WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OFER SAGIV MD (PRESIDENT/OWNER)
(860) 272-4646
Entity
Organization
Contact information
Practice address
540 HOPMEADOW ST, SIMSBURY, CT 06070-2496
(860) 272-4646
(860) 272-4642
Mailing address
540 HOPMEADOW ST, SIMSBURY, CT 06070-2496
(860) 272-4646
(860) 272-4642
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
047333
CT
363AM0700X
Medical Physician Assistant
001816
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
047333
STATE LICENSE
CT
05
—
PENDING
—
CT
Enumeration date
06/01/2015
Last updated
12/14/2016
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