Organization
INTERNAL MEDICINE SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA A REILLY (MANAGER)
(203) 597-0393
Entity
Organization
Contact information
Practice address
1389 W MAIN ST, STE 224, WATERBURY, CT 06708-3104
(203) 597-0393
Mailing address
1389 WEST MAIN ST, STE 224, WATERBURY, CT 06708-0000
(203) 597-0393
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19477
CT
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
19477
CT
363LA2200X
Adult Health Nurse Practitioner
003751
CT
Other
Enumeration date
11/05/2007
Last updated
05/21/2015
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