Provider Demographics
NPI:1720603087
Name:CT OSTEOPATHIC, LLC
Entity Type:Organization
Organization Name:CT OSTEOPATHIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CZARNECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-922-3493
Mailing Address - Street 1:41 BALDWIN LN
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3845
Mailing Address - Country:US
Mailing Address - Phone:860-922-3493
Mailing Address - Fax:
Practice Address - Street 1:41 BALDWIN LN
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3845
Practice Address - Country:US
Practice Address - Phone:860-922-3493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty