Organization
EASTERN CONNECTICUT NEUROLOGY SPECIALIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA WOODRUFF (OFFICE MANAGER)
(860) 647-9183
Entity
Organization
Contact information
Practice address
394 W CENTER ST, MANCHESTER, CT 06040-4735
(860) 647-9183
(860) 647-0582
Mailing address
PO BOX 3262, VERNON, CT 06066-2162
(860) 896-1422
(860) 896-1425
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
039584
CT
363L00000X
Nurse Practitioner
005619
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C03446
MEDICARE GROUP
CT
Enumeration date
06/12/2006
Last updated
04/24/2014
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