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NPI Code Detail

MEDICARE: MYSTIC GERIATRICS, LLC

MEDICARE: MYSTIC GERIATRICS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner
2363LG0600XGerontology Nurse Practitioner
3207QG0300XGeriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number : 1336167238
Entity Type Code : Organization
Provider Name (Legal Business Name) : MYSTIC GERIATRICS, LLC
Provider Business Mailing Address
First Line : 3 HERON RD
Second Line :
City : MYSTIC
State : CT
Zip : 06355-3253
Country : US
Telephone Number : 860-536-5302
Fax Number : 860-536-5302
Provider Business Practice Location Address
First Line : 3 HERON RD
Second Line :
City : MYSTIC
State : CT
Zip : 06355-3253
Country : US
Telephone Number : 860-536-5302
Fax Number : 860-536-5302
Authorized Official
Title or Position : MANAGER
Name : MS. JUNE FLIRI
Credential : M.B.A., M.S.W.
Telephone Number : 860-536-8882
Provider Enumeration Date : 07/18/2006
Last Update Date : 07/20/2015

Similar Medicare Providers

1730182353 — CHERYL A WALKER APRN
Practice Location Address:
3 HERON RD
MYSTIC, CT
06355-3253
Practice Phone: 860-536-6442
Practice Fax: 860-536-6442
1124026869 — DR. HAROLD EUGENE PHILLIPS JR. M.D.
Practice Location Address:
3 HERON RD
MYSTIC, CT
06355-3253
Practice Phone: 860-536-6442
Practice Fax: 860-536-6442
1114943214 — MS. MARY ELLEN PAGNOZZI A.P.R.N.
Practice Location Address:
3 HERON RD
MYSTIC, CT
06355-3253
Practice Phone: 860-536-6442
Practice Fax: 860-536-6442
1689690216 — DR. MICHAEL J FELTES M.D.
Practice Location Address:
3 HERON RD
MYSTIC, CT
06355-3253
Practice Phone: 860-536-6442
Practice Fax: 860-536-6442
1679628820 — MICHAEL J. FELTES, DBA SOUND SENIORS GERIATRICS, MD
Practice Location Address:
3 HERON RD
MYSTIC, CT
06355-3253
Practice Phone: 860-536-6442
Practice Fax: 860-536-6442
1588719736 — MICHAEL J. FELTES,DBA SOUND SENIORS GERIATRICS, APRN
Practice Location Address:
3 HERON RD
MYSTIC, CT
06355-3253
Practice Phone: 860-536-6442
Practice Fax: 860-536-6442

Directions to “MYSTIC GERIATRICS, LLC ” Practice Location

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