Provider Demographics
NPI:1477719839
Name:WOODBURY WALK-IN CLINIC, LLC
Entity Type:Organization
Organization Name:WOODBURY WALK-IN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-264-3319
Mailing Address - Street 1:238 MAIN ST S
Mailing Address - Street 2:P.O. BOX 388
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3407
Mailing Address - Country:US
Mailing Address - Phone:203-263-2282
Mailing Address - Fax:203-263-4030
Practice Address - Street 1:238 MAIN ST S
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3407
Practice Address - Country:US
Practice Address - Phone:203-263-2282
Practice Address - Fax:203-263-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service