Healthcare Provider Details

I. General information

NPI: 1467556753
Provider Name (Legal Business Name): ENFIELD MEDICAL CENTER PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LYNNWOOD DRIVE
LONGMEADOW MA
01106
US

IV. Provider business mailing address

30 LYNNWOOD DRIVE
LONGMEADOW MA
01106
US

V. Phone/Fax

Practice location:
  • Phone: 413-567-5083
  • Fax: 413-567-5098
Mailing address:
  • Phone: 413-567-5083
  • Fax: 413-567-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number016332
License Number StateCT

VIII. Authorized Official

Name: MRS. EILEEN FILIPPINI
Title or Position: SPOUSE
Credential:
Phone: 860-567-5083