Healthcare Provider Details

I. General information

NPI: 1023350014
Provider Name (Legal Business Name): CWC HARTFORD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TOWER SQ 4GS
HARTFORD CT
06183-0001
US

IV. Provider business mailing address

133 E 58TH ST 15TH FLOOR
NEW YORK NY
10022-1236
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-7668
  • Fax: 860-246-7688
Mailing address:
  • Phone: 212-751-8300
  • Fax: 212-813-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY JUDITH SHAW
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 212-751-8300