Healthcare Provider Details

I. General information

NPI: 1831141563
Provider Name (Legal Business Name): NWCT EMERGENCY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 LITCHFIELD ST
TORRINGTON CT
06790-6679
US

IV. Provider business mailing address

PO BOX 1429
LITCHFIELD CT
06759-1429
US

V. Phone/Fax

Practice location:
  • Phone: 860-496-6666
  • Fax:
Mailing address:
  • Phone: 860-496-6435
  • Fax: 860-482-8627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateCT

VIII. Authorized Official

Name: MARK R PRETE
Title or Position: PRESIDENT/GENERAL PARTNER
Credential: MD
Phone: 860-496-6435