Provider Demographics
NPI:1922333525
Name:NUTMEG NATURAL HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:NUTMEG NATURAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DENNERY
Authorized Official - Last Name:STRATFORD
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:203-816-0326
Mailing Address - Street 1:PO BOX 110008
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-0008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4761 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1801
Practice Address - Country:US
Practice Address - Phone:203-816-0326
Practice Address - Fax:203-373-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty