Healthcare Provider Details

I. General information

NPI: 1184995144
Provider Name (Legal Business Name): NEW ENGLAND URGENT CARE ENFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HAZARD AVE
ENFIELD CT
06082-3813
US

IV. Provider business mailing address

55 HAZARD AVE
ENFIELD CT
06082-3813
US

V. Phone/Fax

Practice location:
  • Phone: 860-745-9911
  • Fax: 860-745-7077
Mailing address:
  • Phone: 860-745-9911
  • Fax: 860-745-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL GUTMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 860-236-3911