Organization
TOWN OF BLOOMFIELD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY T GENTILE (AUTHORIZED AGENT)
(800) 452-8191
Entity
Organization
Contact information
Practice address
12 SOUTH WOOD DRIVE, BLOOMFIELD, CT 06002-2444
(860) 243-3482
(860) 242-9316
Mailing address
PO BOX 290184, WETHERSFIELD, CT 06129-0184
(800) 452-8191
(860) 721-6362
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
C011P1
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004099174
—
CT
Enumeration date
10/10/2005
Last updated
09/02/2010
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