Provider Demographics
NPI:1407378946
Name:CONNECTICUT PRIMARY CARE AND WELLNESS PC
Entity Type:Organization
Organization Name:CONNECTICUT PRIMARY CARE AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/CEO
Authorized Official - Prefix:
Authorized Official - First Name:INES
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-768-6770
Mailing Address - Street 1:530 MIDDLEBURY RD STE 103A
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2547
Mailing Address - Country:US
Mailing Address - Phone:203-527-6953
Mailing Address - Fax:203-528-4331
Practice Address - Street 1:530 MIDDLEBURY RD STE 103A
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2547
Practice Address - Country:US
Practice Address - Phone:203-527-6953
Practice Address - Fax:203-528-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-15
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008075293Medicaid