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General NPI Number Information
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NPI Number | 1497462139
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Entity Type | Organization
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Legal Business Name | AMERICAS VETERANS AND PCP CLINIC
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 2044 BRIDGEPORT AVE STE K
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City | MILFORD
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State | CT
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Zip | 06460-4633
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Country | US
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Telephone | 216-688-9320
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Fax | 203-951-3668
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Provider Business Mailing Address
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Address Line | 600 MAIN ST
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City | WORCESTER
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State | MA
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Zip | 01608-2061
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Country | US
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Telephone | 216-688-9320
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Fax |
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Authorized Official
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Title or Position | CLINICAL PROGRAM DIRECTOR
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Name | JAY J. IDREES
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Credential | MD
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Telephone | 216-688-9320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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