Organization
EAR NOSE & THROAT MEDICAL AND SURGICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AGNES CZIBULKA MD (PHYSICIAN PARTNER)
(203) 234-1324
Entity
Organization
Contact information
Practice address
46 PRINCE ST STE 601, NEW HAVEN, CT 06519-1634
(203) 752-1726
(203) 752-1838
Mailing address
31 BROADWAY, NORTH HAVEN, CT 06473-2304
(203) 234-1324
(203) 239-3047
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
004907
CT
Other
Enumeration date
06/12/2012
Last updated
07/16/2012
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