Individual
TARA BRESLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
490 BLUE HILLS AVENUE, MT.SINAI REHABILITATION HOSPITAL/ PHYSICIAN SUITE, HARTFORD, CT 06112-3088
(860) 714-2647
(860) 714-8519
Mailing address
490 BLUE HILLS AVE, MT SINAI REHABILITATION HOSPITAL/PHYSICIANS SUITE, HARTFORD, CT 06112-1513
(860) 714-2647
(860) 714-8519
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
000593
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005930121
CONNECTICARE
CT
01
—
290000593CT03
BLUE CROSS BLUE SHIELD
CT
Enumeration date
08/22/2006
Last updated
09/17/2019
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