Provider Demographics
NPI:1316405186
Name:CT OPTIMAL WELLNESS, LLC
Entity Type:Organization
Organization Name:CT OPTIMAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIZA
Authorized Official - Middle Name:F
Authorized Official - Last Name:PETRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-553-2700
Mailing Address - Street 1:115 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6337
Mailing Address - Country:US
Mailing Address - Phone:203-614-1124
Mailing Address - Fax:
Practice Address - Street 1:115 TECHNOLOGY DR UNIT A103
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6338
Practice Address - Country:US
Practice Address - Phone:203-614-1124
Practice Address - Fax:203-828-0014
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE MEDICAL WELLNESS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care