Provider Demographics
NPI:1518798677
Name:POLARIS PSYCHIATRY LLC
Entity type:Organization
Organization Name:POLARIS PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGGIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-835-7614
Mailing Address - Street 1:674 PROSPECT AVE STE 5B
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4288
Mailing Address - Country:US
Mailing Address - Phone:401-835-7614
Mailing Address - Fax:860-370-4005
Practice Address - Street 1:674 PROSPECT AVE STE 5B
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4288
Practice Address - Country:US
Practice Address - Phone:401-835-7614
Practice Address - Fax:860-370-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty