Healthcare Provider Details

I. General information

NPI: 1265487094
Provider Name (Legal Business Name): CRESCENT STREET OBSTETRICS AND GYNECOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CRESCENT ST
MIDDLETOWN CT
06457
US

IV. Provider business mailing address

49 CRESCENT ST
MIDDLETOWN CT
06457
US

V. Phone/Fax

Practice location:
  • Phone: 860-344-9993
  • Fax:
Mailing address:
  • Phone: 860-344-9993
  • Fax: 860-344-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: SARAH SINAGUGLIA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 860-344-9993