Provider Demographics
NPI:1679379747
Name:FARMINGTON VALLEY DIRECT PRIMARY CARE
Entity type:Organization
Organization Name:FARMINGTON VALLEY DIRECT PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-388-0574
Mailing Address - Street 1:47 PERRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013
Mailing Address - Country:US
Mailing Address - Phone:201-388-0574
Mailing Address - Fax:
Practice Address - Street 1:30 WEST AVON ROAD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-269-3002
Practice Address - Fax:860-255-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty