Healthcare Provider Details

I. General information

NPI: 1497819601
Provider Name (Legal Business Name): ADAM BEN BREINER N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 PARK AVE SUITE 301
TRUMBULL CT
06611-3463
US

IV. Provider business mailing address

5520 PARK AVE SUITE 301
TRUMBULL CT
06611-3463
US

V. Phone/Fax

Practice location:
  • Phone: 203-371-8258
  • Fax:
Mailing address:
  • Phone: 203-371-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000271
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: