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General NPI Number Information
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NPI Number | 1023929718
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Entity Type | Organization
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Legal Business Name | KETAMEND THERAPEUTICS PLLC
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 83 EAST AVE STE 114-116
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City | NORWALK
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State | CT
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Zip | 06851-4920
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Country | US
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Telephone | 203-989-4608
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Fax |
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Provider Business Mailing Address
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Address Line | 6 STEEPLE TOP RD
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City | NORWALK
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State | CT
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Zip | 06853-1039
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Country | US
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Telephone | 203-989-4608
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Fax |
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Authorized Official
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Title or Position | OWNER / MEDICAL DIRECTOR
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Name | DR. ERIC NICHOLAS CHRISTIE
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Credential | DO
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Telephone | 203-989-4608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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