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General NPI Number Information
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NPI Number | 1649929126
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Entity Type | Organization
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Legal Business Name | CONNECTICUT OSTEOPATHIC CENTER
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 141 DOWD AVE
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City | CANTON
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State | CT
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Zip | 06019-2401
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Country | US
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Telephone | 570-498-4879
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Fax |
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Provider Business Mailing Address
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Address Line | 304 W. MAIN ST SUITE 2, #135
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City | AVON
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State | CT
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Zip | 06001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA GRONSKI
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Credential | DO
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Telephone | 570-498-4879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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