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General NPI Number Information
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NPI Number | 1720396567
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Entity Type | Organization
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Legal Business Name | BREITER TECH CORP
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 2842 MAIN ST STE 309
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City | GLASTONBURY
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State | CT
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Zip | 06033-1077
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Country | US
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Telephone | 860-502-4587
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Fax |
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Provider Business Mailing Address
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Address Line | 2842 MAIN ST STE 309
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City | GLASTONBURY
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State | CT
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Zip | 06033-1077
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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 | CEO
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Name | JEFFREY BREITER
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Credential |
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Telephone | 860-502-4587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 021746
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License Number State | CT
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