Provider Demographics
NPI:1700133147
Name:BRIETER T C
Entity Type:Organization
Organization Name:BRIETER T C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSCALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-951-2860
Mailing Address - Street 1:2842 MAIN ST STE 309
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1077
Mailing Address - Country:US
Mailing Address - Phone:860-951-2860
Mailing Address - Fax:
Practice Address - Street 1:2842 MAIN ST STE 309
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1077
Practice Address - Country:US
Practice Address - Phone:860-951-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT41875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty