Organization
ALLIANCE MEDICAL GROUP OF GREATER WATERBURY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ARESCO (PRESIDENT)
(203) 573-9512
Entity
Organization
Contact information
Practice address
1625 STRAITS TPKE, MIDDLEBURY, CT 06762-1836
(203) 573-9512
(203) 568-2904
Mailing address
1625 STRAITS TPKE, SUITE #301, MIDDLEBURY, CT 06762-1836
(203) 573-9512
(203) 568-2904
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004167872
—
CT
05
—
004203056
—
CT
05
—
004213005
—
CT
05
—
004213013
—
CT
05
—
004263977
—
CT
Enumeration date
07/13/2006
Last updated
09/03/2009
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