Healthcare Provider Details

I. General information

NPI: 1396935615
Provider Name (Legal Business Name): NORTHWEST CONNECTICUT PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 EAST MAIN ST
TORRINGTON CT
06790-3918
US

IV. Provider business mailing address

895 EAST MAIN ST
TORRINGTON CT
06790-3918
US

V. Phone/Fax

Practice location:
  • Phone: 860-489-1291
  • Fax: 860-489-1804
Mailing address:
  • Phone: 860-489-1291
  • Fax: 860-489-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number021448
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number004854
License Number StateCT

VIII. Authorized Official

Name: DR. DENNIS JAY GOTTFRIED
Title or Position: PARTNER
Credential: M.D.
Phone: 860-489-1291