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General NPI Number Information
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NPI Number | 1336897875
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Entity Type | Organization
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Legal Business Name | CORNERSTONE PRACTICE
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 585 BURNSIDE AVE
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City | EAST HARTFORD
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State | CT
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Zip | 06108-3537
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Country | US
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Telephone | 860-890-1175
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Fax |
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Provider Business Mailing Address
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Address Line | 266 CONNECTICUT AVE
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City | NEWINGTON
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State | CT
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Zip | 06111-2115
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Country | US
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Telephone | 860-890-1175
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | ADEKOLA ADEDEJI
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Credential |
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Telephone | 860-890-1175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | NULL
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