Provider Demographics
NPI:1013193952
Name:TOWN OF GLASTONBURY
Entity Type:Organization
Organization Name:TOWN OF GLASTONBURY
Other - Org Name:HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH,RS
Authorized Official - Phone:860-652-7534
Mailing Address - Street 1:2155 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-6523
Mailing Address - Country:US
Mailing Address - Phone:860-652-7534
Mailing Address - Fax:860-652-7533
Practice Address - Street 1:2155 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-6523
Practice Address - Country:US
Practice Address - Phone:860-652-7534
Practice Address - Fax:860-652-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT600000032Medicare PIN