Healthcare Provider Details

I. General information

NPI: 1447597315
Provider Name (Legal Business Name): NEW ENGLAND FOOD ALLERGY TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 FARMINGTON AVE SUITE 138
WEST HARTFORD CT
06119-1505
US

IV. Provider business mailing address

836 FARMINGTON AVE SUITE 138
WEST HARTFORD CT
06119-1505
US

V. Phone/Fax

Practice location:
  • Phone: 860-986-6099
  • Fax: 860-761-2674
Mailing address:
  • Phone: 860-986-6099
  • Fax: 860-761-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number031434
License Number StateCT

VIII. Authorized Official

Name: DR. JEFFREY MARTIN FACTOR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 860-916-0273