Provider Demographics
NPI:1437422961
Name:CITY OF MIDDLETOWN HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CITY OF MIDDLETOWN HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAVLICEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-344-3474
Mailing Address - Street 1:245 DEKOVEN DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3460
Mailing Address - Country:US
Mailing Address - Phone:860-344-3474
Mailing Address - Fax:860-344-3588
Practice Address - Street 1:245 DEKOVEN DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3460
Practice Address - Country:US
Practice Address - Phone:860-344-3474
Practice Address - Fax:860-344-3588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF MIDDLETOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare