Healthcare Provider Details

I. General information

NPI: 1952280034
Provider Name (Legal Business Name): TOWN OF EAST HADDAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PLAINS RD
MOODUS CT
06469-1125
US

IV. Provider business mailing address

PO BOX 290184
WETHERSFIELD CT
06129-0184
US

V. Phone/Fax

Practice location:
  • Phone: 800-336-6402
  • Fax:
Mailing address:
  • Phone: 800-336-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DOW
Title or Position: CREDENTIALING
Credential:
Phone: 800-336-6402