Organization
EASTERN CONNECTICUT EAR, NOSE & THROAT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA TINO (PRACTICE MANAGER)
(860) 456-0287
Entity
Organization
Contact information
Practice address
36 WATSON ST, WILLIMANTIC, CT 06226-2122
(860) 456-0287
(860) 456-3532
Mailing address
36 WATSON ST, WILLIMANTIC, CT 06226-2122
(860) 456-0287
(860) 456-3532
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YS0123X
Facial Plastic Surgery Physician
—
—
207YX0602X
Otolaryngic Allergy Physician
—
—
332S00000X
Hearing Aid Equipment
000208
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004054151
—
CT
05
—
004170742
—
CT
Enumeration date
11/30/2006
Last updated
02/22/2018
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