Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 022670 | CT |
NPI | 1184666430 |
---|---|
Provider Name | Dr. Alicja Jadwiga Harbut III |
First Address | New Britain, CT 06053-3509 |
Second Address | New Britain, CT 06053-3509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 19/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B84146 | (02) | CT |