Organization
VA-CT HEALTHCARE SYSTEM
Active
Organization
VA-CT HEALTHCARE SYSTEM
Active
Other names
Opioid Treatment Program
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KISHORCHANDRA R GONSAI MD (PHYSICIAN/PSYCHATRYMEDICAL DIRECTOR)
(203) 932-5711
Entity
Organization
Contact information
Practice address
950 CAMPBELL AVE, BULD# 36, MAIL CODE 116 A4, WEST HAVEN, CT 06516-2770
(203) 932-5711
(203) 937-3478
Mailing address
950 CAMPBELL AVE, BULD# 36, MAIL CODE 116 A4, WEST HAVEN, CT 06516-2770
(203) 932-5711
(203) 937-3478
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
036772
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036772
PHYSICIAN
CT
Enumeration date
09/12/2006
Last updated
08/22/2020
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