Healthcare Provider Details

I. General information

NPI: 1194770040
Provider Name (Legal Business Name): PHYSICIANS HEALTH & WELLNESS CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 NEW HAVEN RD
NAUGATUCK CT
06770-4782
US

IV. Provider business mailing address

PO BOX 617
NAUGATUCK CT
06770-0617
US

V. Phone/Fax

Practice location:
  • Phone: 203-723-4032
  • Fax: 203-723-4753
Mailing address:
  • Phone: 203-723-4032
  • Fax: 203-723-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: SCOTT A HODES
Title or Position: SENIOR MANAGER
Credential: D C
Phone: 203-723-4032