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General NPI Number Information
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NPI Number | 1679379747
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Entity Type | Organization
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Legal Business Name | FARMINGTON VALLEY DIRECT PRIMARY CARE
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 30 WEST AVON ROAD
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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 | 860-269-3002
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Fax | 860-255-4002
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Provider Business Mailing Address
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Address Line | 47 PERRY DRIVE
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City | BURLINGTON
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State | CT
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Zip | 06013
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Country | US
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Telephone | 201-388-0574
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JUDY CHIU
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Credential | DO
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Telephone | 201-388-0574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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