Healthcare Provider Details

I. General information

NPI: 1497769608
Provider Name (Legal Business Name): GINA MORGENSTEIN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BARNES RD
WALLINGFORD CT
06492-1832
US

IV. Provider business mailing address

85 BARNES RD
WALLINGFORD CT
06492-1832
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3280
  • Fax: 203-741-6569
Mailing address:
  • Phone: 203-265-3280
  • Fax: 203-741-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000214
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: