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General NPI Number Information
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NPI Number | 1710497607
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Entity Type | Organization
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Legal Business Name | GENESIS MEDICA URGENT CARE GROUP LLC
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1427 CHAPEL ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-4403
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Country | US
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Telephone | 203-865-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 1427 CHAPEL ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-4403
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Country | US
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Telephone | 203-865-3880
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. TERRY CHOSZCZYK
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Credential |
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Telephone | 203-865-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 036883
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License Number State | CT
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