Organization
GERICARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN J BRENES (CEO)
(203) 910-7533
Entity
Organization
Contact information
Practice address
464 WOLCOTT RD, WOLCOTT, CT 06716-2626
(203) 633-4560
Mailing address
464 WOLCOTT RD, WOLCOTT, CT 06716-2626
(203) 633-4560
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/15/2008
Last updated
02/22/2011
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