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General NPI Number Information
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NPI Number | 1730623737
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Entity Type | Organization
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Legal Business Name | MEDITOX CARE, LLC
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Dates
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Enumeration Date | 12/09/2016
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 179 POST RD W
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City | WESTPORT
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State | CT
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Zip | 06880-4602
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Country | US
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Telephone | 203-450-4882
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Fax | 866-505-8927
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Provider Business Mailing Address
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Address Line | 179 POST RD W
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City | WESTPORT
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State | CT
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Zip | 06880-4602
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Country | US
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Telephone | 203-450-4882
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Fax | 866-505-8927
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Authorized Official
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Title or Position | OWNER AND MANAGER
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Name | MOHAMED ELSAMRA
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Credential | MD
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Telephone | 203-450-4882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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