Healthcare Provider Details

I. General information

NPI: 1962062810
Provider Name (Legal Business Name): ARIEL MORLEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 RIVERSIDE AVENUE
BRISTOL CT
06010
US

IV. Provider business mailing address

6131 TOWN PL
MIDDLETOWN CT
06457-1760
US

V. Phone/Fax

Practice location:
  • Phone: 833-424-3627
  • Fax:
Mailing address:
  • Phone: 203-895-3699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberPENDING
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4623
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: