Provider Demographics
NPI:1750444634
Name:HEBRON FAMILY PHYSICIANS LLC
Entity Type:Organization
Organization Name:HEBRON FAMILY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:GILDERSLEEVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-228-1119
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248
Mailing Address - Country:US
Mailing Address - Phone:860-228-1119
Mailing Address - Fax:860-228-4314
Practice Address - Street 1:23 A LIBERTY DRIVE
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248
Practice Address - Country:US
Practice Address - Phone:860-228-1119
Practice Address - Fax:860-228-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02821Medicare PIN