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General NPI Number Information
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NPI Number | 1508981713
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Entity Type | Organization
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Legal Business Name | EAR NOSE & THROAT SPECIALISTS OF CENTRAL CONNECTICUT P.C.
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 233 MAIN ST 5TH FLOOR
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City | NEW BRITAIN
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State | CT
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Zip | 06051-4204
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Country | US
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Telephone | 860-225-7761
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Fax | 860-225-6657
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Provider Business Mailing Address
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Address Line | 233 MAIN ST 5TH FLOOR
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City | NEW BRITAIN
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State | CT
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Zip | 06051-4204
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Country | US
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Telephone | 860-225-7761
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Fax | 860-225-6657
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Authorized Official
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Title or Position | OTOLARYNGOLOGIST
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Name | DR. ROBERT ANDRE GRYBOSKI
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Credential | M.D.
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Telephone | 860-225-7761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 12647
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License Number State | CT
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