Provider Demographics
NPI:1912636614
Name:ROOTS NATURAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ROOTS NATURAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:860-471-1434
Mailing Address - Street 1:106 ROUTE 66 E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-1224
Mailing Address - Country:US
Mailing Address - Phone:860-471-1434
Mailing Address - Fax:
Practice Address - Street 1:106 ROUTE 66 E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237-1224
Practice Address - Country:US
Practice Address - Phone:860-471-1434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty