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General NPI Number Information
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NPI Number | 1831462514
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Entity Type | Organization
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Legal Business Name | GARNER CORRECTIONAL INSTITUTION
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Dates
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Enumeration Date | 02/11/2012
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Last Update Date | 02/11/2012
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Provider Practice Location Address
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Address Line | 50 NUNNAWAUK RD
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City | NEWTOWN
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State | CT
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Zip | 06470-2319
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Country | US
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Telephone | 203-270-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 50 NUNNAWAUK RD
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City | NEWTOWN
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State | CT
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Zip | 06470-2319
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Country | US
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Telephone | 203-270-2608
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Fax |
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Authorized Official
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Title or Position | CHIEF, CMHC
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Name | DR. ROBERT BERGER
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Credential | M.D.
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Telephone | 860-679-5589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 021797
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License Number State | CT
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