Organization
COTTAGE GROVE CARDIOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY SIMONS (OFFICE ASSISTANT)
(860) 242-8756
Entity
Organization
Contact information
Practice address
711 COTTAGE GROVE ROAD, BLOOMFIELD, CT 06002-3060
(860) 242-8756
(860) 242-3052
Mailing address
711 COTTAGE GROVE ROAD, BLOOMFIELD, CT 06002-3060
(860) 242-8756
(860) 242-3052
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
CT
207RC0000X
Cardiovascular Disease Physician
—
—
363L00000X
Nurse Practitioner
002892
CT
363L00000X
Nurse Practitioner
3110
CT
363LF0000X
Family Nurse Practitioner
5854
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004090958
—
CT
01
—
C00718
MEDICARE
CT
01
—
CA8569
RAILROAD MEDICARE
—
Enumeration date
05/05/2006
Last updated
11/05/2014
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