Provider Demographics
NPI:1417255068
Name:NORTHEAST DISTRICT DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:NORTHEAST DISTRICT DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-774-7350
Mailing Address - Street 1:69 S MAIN ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-3829
Mailing Address - Country:US
Mailing Address - Phone:860-774-7350
Mailing Address - Fax:
Practice Address - Street 1:69 S MAIN ST
Practice Address - Street 2:UNIT 4
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234-3829
Practice Address - Country:US
Practice Address - Phone:860-774-7350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT999DPH407251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare