Organization
EASTER SEAL REHABILITATION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY NIELSEN (CFO/COO)
(203) 754-5141
Entity
Organization
Contact information
Practice address
22 TOMPKINS ST, WATERBURY, CT 06708-1496
(203) 754-5141
(203) 757-1198
Mailing address
22 TOMPKINS ST, WATERBURY, CT 06708-1496
(203) 754-5141
(203) 757-1198
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
332S00000X
Hearing Aid Equipment
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017500
CONNECTICARE
CT
01
—
12DME0601CT01
ANTHEM BLUE CROSS BLUE SHIELD
CT
01
—
232000
CONNECTICARE
—
01
—
5376280
AETNA
—
01
—
5617574
AETNA
CT
01
—
800009105CT01
ANTHEM BLUE CROSS BLUE SHIELD
CT
Enumeration date
03/17/2011
Last updated
06/21/2023
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