Connecticut Go Green Medical PLLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

CONNECTICUT GO GREEN MEDICAL PLLC

Practice address

31 Cherry St
Unit 1
Milford, CT 06460-3465

Phone

(203) 874-7001

Fax

(203) 874-7002

NPI assigned

Dec 14, 2023

Last updated

Dec 14, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Deloretta T Eckenrode, APRNNPI 1083663058

Title

Owner

Phone

(203) 874-7001

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deloretta Theresa Eckenrode, NP

  • Family Nurse Practitioner
  • Milford, CT
  • NPI 1083663058
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1702512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702512000000",
    "number": "1881462232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 CHERRY ST UNIT 1",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603465",
            "telephone_number": "203-874-7001",
            "fax_number": "203-874-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 CHERRY ST",
            "address_2": "UNIT 1",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603465",
            "telephone_number": "203-874-7001",
            "fax_number": "203-874-7002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT GO GREEN MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-14",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A",
        "authorized_official_last_name": "ECKENRODE",
        "authorized_official_first_name": "DELORETTA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-874-7001",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Milford, CT
• Providers in Milford, CT by specialty
• Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.