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General NPI Number Information
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NPI Number | 1639057029
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Entity Type | Organization
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Legal Business Name | CONCIERGE BY NRC
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 1224 MILL ST STE 224
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City | EAST BERLIN
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State | CT
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Zip | 06023-1159
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Country | US
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Telephone | 657-566-2588
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Fax | 603-392-7786
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Provider Business Mailing Address
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Address Line | 1224 MILL ST STE 224
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City | EAST BERLIN
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State | CT
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Zip | 06023-1159
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Country | US
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Telephone | 657-566-2588
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Fax | 603-392-7786
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Authorized Official
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Title or Position | PHLEBOTOMIST
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Name | NELLIE ROSALIE RUSSOTTO
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Credential | PBT
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Telephone | 657-566-2588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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