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DR. ELISSA LANE FREEDMAN
>> Family Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1013197722
Individual Registrant:DR. ELISSA LANE FREEDMAN
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
23 LIBERTY DR SUITE A HEBRON, CT 06248-1553 US
Tel: 860-228-1119 Fax: 860-228-4314
Tel: 860-228-1119 Fax: 860-228-4314
Contact information for business:
23 LIBERTY DR SUITE A HEBRON, CT 06248-1553 US
Tel: 860-228-1119 Fax: 860-228-4314
Tel: 860-228-1119 Fax: 860-228-4314
Registration Information:
NPI: 1013197722
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | CT | 050034 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| NPI | 1013197722 | 01 | |
| 004236164 | CT | 05 |
