Healthcare Provider Details

I. General information

NPI: 1326362799
Provider Name (Legal Business Name): NAUGATUCK VALLEY EAR, NOSE AND THROAT ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 GRANDVIEW AVENUE SUITE 201
WATERBURY CT
06708-2520
US

IV. Provider business mailing address

171 GRANDVIEW AVENUE SUITE 201
WATERBURY CT
06708-2520
US

V. Phone/Fax

Practice location:
  • Phone: 203-753-8833
  • Fax: 203-753-6744
Mailing address:
  • Phone: 203-753-8833
  • Fax: 203-753-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND E. WINICKI
Title or Position: PRINCIPAL MEMBER
Credential: M.D.
Phone: 203-753-8833