CT Optimal Wellness, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CT OPTIMAL WELLNESS, LLC

Practice address

115 Technology Dr Unit A103
Trumbull, CT 06611-6338

Phone

(203) 614-1124

Fax

(203) 828-0014

NPI assigned

Mar 11, 2019

Last updated

Mar 11, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

COMPREHENSIVE MEDICAL WELLNESS, PLLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Luiza F Petre, MD

Title

Owner

Phone

(917) 553-2700

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

CT Optimal Wellness LLC2 organizations share this tax ID, including this one

Part of

CT Optimal Wellness LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• CT Optimal Wellness, LLC

  • Primary Care Clinic/Center
  • Hartford, CT
  • NPI 1770014656
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552262400000",
    "number": "1316405186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 TECHNOLOGY DR",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066116337",
            "telephone_number": "203-614-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 TECHNOLOGY DR UNIT A103",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066116338",
            "telephone_number": "203-614-1124",
            "fax_number": "203-828-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CT OPTIMAL WELLNESS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMPREHENSIVE MEDICAL WELLNESS, PLLC",
        "enumeration_date": "2019-03-11",
        "last_updated": "2019-03-11",
        "status": "A",
        "authorized_official_last_name": "PETRE",
        "authorized_official_first_name": "LUIZA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-553-2700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• CP Dentistry LLC (Cosmetic & Preventive Dentistry)
• Suniya H Crawley
• Susanna Dahl Cronmiller, F.N.P, APRN
• CT Comprehensive Medical PLLC
• CT Fertility, PC
• Christine Cunningham, APRN
• Michael Cydylo
• Gregory John Daley, BCBA
• Regina Daley
• Sheetal Damania

• Primary Care Clinic/Center in Trumbull, CT
• Providers in Trumbull, CT by specialty
• Primary Care Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.