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General NPI Number Information
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NPI Number | 1437422961
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Entity Type | Organization
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Legal Business Name | CITY OF MIDDLETOWN HEALTH DEPARTMENT
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 245 DEKOVEN DR
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3460
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Country | US
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Telephone | 860-344-3474
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Fax | 860-344-3588
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Provider Business Mailing Address
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Address Line | 245 DEKOVEN DR
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3460
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Country | US
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Telephone | 860-344-3474
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Fax | 860-344-3588
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Authorized Official
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Title or Position | DIRECTOR OF HEALTH
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Name | JOSEPH A. HAVLICEK
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Credential | M.D.
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Telephone | 860-344-3474
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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 |
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License Number State | CT
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