Healthcare Provider Details

I. General information

NPI: 1912942392
Provider Name (Legal Business Name): NOEMI JUDIT MEZEI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E MIDDLE TPKE
MANCHESTER CT
06040-3710
US

IV. Provider business mailing address

167 RIDGE RD
GLASTONBURY CT
06033-1900
US

V. Phone/Fax

Practice location:
  • Phone: 860-647-9648
  • Fax: 860-647-1364
Mailing address:
  • Phone: 860-657-3841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number030852
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: