Healthcare Provider Details

I. General information

NPI: 1437145224
Provider Name (Legal Business Name): BROOK M. SEELEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 FARMINGTON AVE. SUITE 210
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

499 FARMINGTON AVE STE 210
FARMINGTON CT
06032-1933
US

V. Phone/Fax

Practice location:
  • Phone: 860-676-2472
  • Fax: 860-678-9119
Mailing address:
  • Phone: 860-676-2472
  • Fax: 860-678-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number040639
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number040639
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: