Organization
CITY OF NEW LONDON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RON SAMUL (CHIEF)
(860) 447-5291
Entity
Organization
Contact information
Practice address
289 BANK ST, NEW LONDON, CT 06320-5521
(860) 447-5291
Mailing address
269 MAIN ST, CROMWELL, CT 06416-2302
(860) 638-1800
(860) 638-1802
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004072500
—
CT
01
—
590069399
RAILROAD MEDICARE
—
01
—
710C095A2CT01
BLUE CROSS/BLUE SHIELD
—
01
—
CT0476
HEALTHNET
—
Enumeration date
09/19/2005
Last updated
09/21/2010
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