Provider Demographics
NPI:1447796883
Name:NOLA DARIEN, LLC
Entity Type:Organization
Organization Name:NOLA DARIEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:GROMELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:917-687-7934
Mailing Address - Street 1:1540 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5940
Mailing Address - Country:US
Mailing Address - Phone:203-309-5303
Mailing Address - Fax:203-309-5306
Practice Address - Street 1:1540 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5940
Practice Address - Country:US
Practice Address - Phone:203-309-5303
Practice Address - Fax:203-309-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009620261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy