Organization
UCONN FIRE DEPARTMENT MICU - NEONATAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY T GENTILE (AUTHORIZED AGENT)
(800) 452-8191
Entity
Organization
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 674-2525
(860) 679-1199
Mailing address
PO BOX 290184, WETHERSFIELD, CT 06129-0184
(800) 452-8191
(860) 721-6362
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
C052P1
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004223450
—
CT
01
—
1871581223
RAILROAD MEDICARE
CT
Enumeration date
10/10/2005
Last updated
10/16/2008
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