Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 00310 | CT |
NPI | 1023289881 |
---|---|
Provider Name | Dr. Lisa J Gengo |
First Address | Norwalk, CT 06851-4720 |
Second Address | Norwalk, CT 06851-4720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2008 |
Last Update Date | 07/08/2013 |