Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 8725 | CT |
Y | 213EG0000X | General Practice | 8725 | CT |
NPI | 1003001207 |
---|---|
Provider Name | Dr. Niloo Gorji |
First Address | Tolland, CT 06084-3961 |
Second Address | Tolland, CT 06084-3961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 11/09/2007 |