MEDICARE: THE GARVIN GROUP DBA PASSPORT HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1083854269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GARVIN GROUP DBA PASSPORT HEALTH

Provider Business Mailing Address
First Line	:	1100 BEDFORD ST
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5305
Country	:	US
Telephone Number	:	203-406-9655
Fax Number	:	203-406-9978

Provider Business Practice Location Address
First Line	:	1100 BEDFORD ST
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5305
Country	:	US
Telephone Number	:	203-406-9655
Fax Number	:	203-406-9978

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. BARBARA JAN-MEE WONG
Credential	:	R.N.
Telephone Number	:	203-406-9655

Provider Enumeration Date	:	02/27/2009
Last Update Date	:	02/27/2009

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