Organization
CITY OF ANSONIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY GENTILE (AUTHORIZED AGENT)
(800) 452-8191
Entity
Organization
Contact information
Practice address
22 W MAIN ST, ANSONIA, CT 06401-1812
(203) 735-6891
(203) 732-5157
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
C002B1
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004126282
—
CT
01
—
1558359919
RAILROAD MEDICARE
CT
Enumeration date
10/11/2005
Last updated
10/22/2008
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