Provider Demographics
NPI:1952599151
Name:TOWN OF WINDSOR
Entity Type:Organization
Organization Name:TOWN OF WINDSOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETRILLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DRPH
Authorized Official - Phone:860-285-1823
Mailing Address - Street 1:275 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2940
Mailing Address - Country:US
Mailing Address - Phone:860-285-1823
Mailing Address - Fax:860-285-1864
Practice Address - Street 1:275 BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2940
Practice Address - Country:US
Practice Address - Phone:860-285-1823
Practice Address - Fax:860-285-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT990000645Medicare PIN