Middlesex Hospital Dba Family Practice Group East Hampton
Organization Active NPI Family Medicine Physician · East Hampton, CT
NPI 1114062114 · NPPES record last updated Mar 6, 2019
Key facts
- NPI
- 1114062114
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MIDDLESEX HOSPITAL DBA FAMILY PRACTICE GROUP EAST HAMPTON
- Practice address
- 42 E High St
East Hampton, CT 06424-1099 - Phone
- (860) 344-6394
- Fax
- (860) 344-6748
- NPI assigned
- Feb 20, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- MIDDLESEX HOSPITAL
Authorized official
- Name
- Marisa Pellerin
- Title
- Credentialing/Enrollment
- Phone
- (860) 358-4821
Corporate family (same tax ID) 15
National Provider Directory
- Tax ID family
- Middlesex Hospital Dba Middlesex Hospital Physician Services
- Part of
- Middlesex Hospital Dba Middlesex Hospital Physician Services
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | CT | Yes | |
| Geriatric Medicine (Family Medicine) Physician |
207QG0300X | CT | ||
| Obstetrics & Gynecology Physician |
207V00000X | CT | ||
| Pediatrics Physician |
208000000X | CT | ||
| Medical Physician Assistant |
363AM0700X | CT |
Addresses
Primary practice location
42 E High St
East Hampton, CT 06424-1099
Mailing address
90 S Main St
Middletown, CT 06457-3649
Phone (860) 358-6394
Other names
- Family Practice Group East Hampton
Other providers in East Hampton, CT
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- Elissa Ann Matrisciano
- Julie Mazzone
- Cheri McKenna
- Judith Marie Mezzomo
- Maryann Millette
- Cody Morrissey
- Tyler Naef
- Arva Nerenxa
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All providers in East Hampton, CT · Family Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.