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General NPI Number Information
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NPI Number | 1417255068
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Entity Type | Organization
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Legal Business Name | NORTHEAST DISTRICT DEPARTMENT OF HEALTH
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Dates
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Enumeration Date | 03/07/2011
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 69 S MAIN ST UNIT 4
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City | BROOKLYN
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State | CT
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Zip | 06234-3829
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Country | US
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Telephone | 860-774-7350
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Fax |
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Provider Business Mailing Address
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Address Line | 69 S MAIN ST UNIT 4
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City | BROOKLYN
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State | CT
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Zip | 06234-3829
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Country | US
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Telephone | 860-774-7350
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF HEALTH
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Name | MS. SUSAN STARKEY
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Credential |
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Telephone | 860-774-7350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 999DPH407
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License Number State | CT
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