Provider Demographics
NPI:1477311413
Name:PRIMARY HEALTH OF CONNECTICUT PLLC
Entity Type:Organization
Organization Name:PRIMARY HEALTH OF CONNECTICUT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKSYMIW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-231-6304
Mailing Address - Street 1:68 TAIT RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3844
Mailing Address - Country:US
Mailing Address - Phone:203-231-6304
Mailing Address - Fax:
Practice Address - Street 1:324 ELM ST STE 203A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2282
Practice Address - Country:US
Practice Address - Phone:203-231-6304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care