Provider Demographics
NPI:1457866485
Name:NEW ENGLAND CENTER FOR HEALTH AND NUTRITION LLC
Entity Type:Organization
Organization Name:NEW ENGLAND CENTER FOR HEALTH AND NUTRITION LLC
Other - Org Name:INTEGRATED NEUROLOGY OF CONNECTICUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DOERING
Authorized Official - Suffix:
Authorized Official - Credentials:ACNS-BC
Authorized Official - Phone:860-840-1058
Mailing Address - Street 1:73 SECKAR RD
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06278-1035
Mailing Address - Country:US
Mailing Address - Phone:860-840-1058
Mailing Address - Fax:
Practice Address - Street 1:39 NOTT HWY
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:CT
Practice Address - Zip Code:06278-1341
Practice Address - Country:US
Practice Address - Phone:860-840-1058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPENDING261QM2500X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty