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Contact Information

MYSTIC GERIATRICS, LLC
3 HERON RD
MYSTIC, CT06355-3253
 Phone: 860-536-5302
 Fax: 860-536-5302
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
 

Acute Care

363LA2100X 50 Nurse Practitioner
 

Gerontology

363LG0600X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for MYSTIC GERIATRICS, LLC

NPI # 1336167238
LBN Legal business name MYSTIC GERIATRICS, LLC
Authorized official JUNE FLIRI - (MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/18/2006
Last updated 07/20/2015 - About 11 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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