| Opioid Treatment Program | |
|
950 Campbell Ave Buld# 36, Mail Code 116 A4 West Haven CT 06516-2770 | |
| (203) 932-5711 | |
| (203) 937-3478 |
| Full Name | Opioid Treatment Program |
|---|---|
| Speciality | Clinic/center |
| Location | 950 Campbell Ave, West Haven, Connecticut |
| Authorized Official Name and Position | Kishorchandra R Gonsai (PHYSICIAN/PSYCHATRYMEDICAL DIRECTOR) |
| Authorized Official Contact | 2039325711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Opioid Treatment Program 950 Campbell Ave Buld# 36, Mail Code 116 A4 West Haven CT 06516-2770 Ph: (203) 932-5711 | Opioid Treatment Program 950 Campbell Ave Buld# 36, Mail Code 116 A4 West Haven CT 06516-2770 Ph: (203) 932-5711 |
| NPI Number | 1295839900 |
|---|---|
| Provider Enumeration Date | 09/12/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295839900 | NPI | - | NPPES |
| 036772 | Other | CT | PHYSICIAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 036772 (Connecticut) | Primary |
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