Provider Demographics
NPI:1083854269
Name:THE GARVIN GROUP DBA PASSPORT HEALTH
Entity Type:Organization
Organization Name:THE GARVIN GROUP DBA PASSPORT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JAN-MEE
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:203-406-9655
Mailing Address - Street 1:1100 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5305
Mailing Address - Country:US
Mailing Address - Phone:203-406-9655
Mailing Address - Fax:203-406-9978
Practice Address - Street 1:1100 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5305
Practice Address - Country:US
Practice Address - Phone:203-406-9655
Practice Address - Fax:203-406-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty