Provider Demographics
NPI:1811221955
Name:NEW HAVNE NATUROPATHIC CENTER
Entity Type:Organization
Organization Name:NEW HAVNE NATUROPATHIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:BOTWICK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:203-387-5015
Mailing Address - Street 1:1079 WHALLEY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1783
Mailing Address - Country:US
Mailing Address - Phone:203-387-5015
Mailing Address - Fax:203-387-3500
Practice Address - Street 1:1079 WHALLEY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1783
Practice Address - Country:US
Practice Address - Phone:203-387-5015
Practice Address - Fax:203-387-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT#000301175F00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty