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General NPI Number Information
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NPI Number | 1538152921
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Entity Type | Individual
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Provider Name | KARL STEWART NEUBECKER M.M.SC., PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 05/08/2017
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Provider Practice Location Address
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Address Line | 7 SUMMIT CIR
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City | ELLINGTON
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State | CT
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Zip | 06029-3897
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Country | US
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Telephone | 860-268-9447
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Fax |
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Provider Business Mailing Address
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Address Line | 270 FARMINGTON AVE STE 102
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City | FARMINGTON
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State | CT
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Zip | 06032-1920
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Country | US
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Telephone | 860-549-8276
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Fax | 860-674-8084
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 001444
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License Number State | CT
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