MEDICARE: GINA MORGENSTEIN P.A.

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	363A00000X	Physician Assistant	000214	CT

General Provider Information

NPI Number	:	1497769608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MORGENSTEIN P.A.

Provider Business Mailing Address
First Line	:	85 BARNES RD
Second Line	:
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-1832
Country	:	US
Telephone Number	:	203-265-3280
Fax Number	:	203-741-6569

Provider Business Practice Location Address
First Line	:	85 BARNES RD
Second Line	:
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-1832
Country	:	US
Telephone Number	:	203-265-3280
Fax Number	:	203-741-6569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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