NPI 1104131283

Masonicare

Organisation Rehabilitation Hospital Wallingford, CT

Practice location

Address: 22 Masonic Ave Rehab Department, Wallingford, CT 06492-3048
Phone: (203) 679-5900
Fax: (203) 679-6142

Authorised official

Name: Susan Fagan
Title: Rehab Director
Phone: (203) 679-6247

Registered specialties

Rehabilitation Hospital Primary

Hospitals Taxonomy 283X00000X Licence 003288 (CT)

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Registry record

NPI: 1104131283
Entity type: Organization
NPI issued: 12 Aug 2010
Record last updated: 12 Aug 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.