| |
110 Main St 1st Fl East Hartford CT 06118-3208 | |
(860) 569-4430 | |
(860) 569-4431 |
Full Name | |
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Speciality | Family Medicine |
Location | 110 Main St, East Hartford, Connecticut |
Authorized Official Name and Position | Joseph Michael Danyliw (OWNER) |
Authorized Official Contact | 8605694430 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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110 Main St 1st Fl East Hartford CT 06118-3208 Ph: (860) 569-4430 | 110 Main St 1st Fl East Hartford CT 06118-3208 Ph: (860) 569-4430 |
NPI Number | 1659552768 |
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Provider Enumeration Date | 11/16/2007 |
Last Update Date | 11/16/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659552768 | NPI | - | NPPES |
1058742 | Medicaid | CT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 005874 (Connecticut) | Primary |
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