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NPI Code Detail

MEDICARE: DR. WAZIDA TABASSUM DC

MEDICARE: DR. WAZIDA TABASSUM DC
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
1111NR0400XRehabilitation Chiropractor001764CT

General Provider Information

NPI Number : 1811157431
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WAZIDA TABASSUM DC
Provider Business Mailing Address
First Line : 345 BUCKLAND HILLS DR
Second Line : APT 11232
City : MANCHESTER
State : CT
Zip : 06042-8704
Country : US
Telephone Number : 203-209-4788
Fax Number :
Provider Business Practice Location Address
First Line : 74 PARK RD
Second Line : SUITE # 4
City : WEST HARTFORD
State : CT
Zip : 06119-1853
Country : US
Telephone Number : 860-218-1725
Fax Number : 860-218-1727
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2008
Last Update Date : 09/02/2010

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