Physician Services of Northeast

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PHYSICIAN SERVICES OF NORTHEAST

Doing business as

Physician Services of Northeast Connecticut, LLC

Practice address

320 Pomfret St
Suite CSB2
Putnam, CT 06260-1836

Phone

(860) 928-6541

Fax

(860) 963-6450

NPI assigned

May 14, 2008

Organization subpart

Yes

Parent organization

DAY KIMBALL HEALTHCARE INC DBA DAAs reported in NPPES

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

Authorized official

Name

Julie Drouin

Title

Cfo

Phone

(860) 928-6541

Specialties & licenses 7

Addresses

Other identifiers 2

Other names 1

• Physician Services of Northeast Connecticut, LLC Doing business as

Part of

Day Kimball Healthcare Inc

Locations

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316131200000",
    "number": "1891962221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 POMFRET ST",
            "address_2": "SUITE CSB2",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062601836",
            "telephone_number": "860-928-6541",
            "fax_number": "860-963-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 POMFRET ST",
            "address_2": "SUITE CSB2",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062601836",
            "telephone_number": "860-928-6541",
            "fax_number": "860-963-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SERVICES OF NORTHEAST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAY KIMBALL HEALTHCARE INC DBA DA",
        "enumeration_date": "2008-05-14",
        "last_updated": "2011-09-16",
        "status": "A",
        "authorized_official_last_name": "DROUIN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "860-928-6541"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Midwife",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008001905",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008014016",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physician Services of Northeast Connecticut, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cynthia Petersons
• Bethany G. Petrella, P.T. , M.S.P.T.
• Physician Services of Northeast
• Physician Services of Northeast
• Physician Services of Northeast
• Physician Services of Northeast Connecticut, LLC
• Physicians Services of Northeast CT LLC
• Violet Pietrowski
• Johanna Pike, LPC, MAAT
• Eddy Pimental

• Family Medicine Physician in Putnam, CT
• Providers in Putnam, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.