Provider Demographics
NPI:1538869813
Name:NEW LONDON NATURAL HEALTH CENTER
Entity type:Organization
Organization Name:NEW LONDON NATURAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:860-650-1030
Mailing Address - Street 1:154 HEMPSTEAD ST FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5638
Mailing Address - Country:US
Mailing Address - Phone:860-650-1030
Mailing Address - Fax:855-869-4891
Practice Address - Street 1:154 HEMPSTEAD ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5638
Practice Address - Country:US
Practice Address - Phone:860-650-1030
Practice Address - Fax:855-869-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093067019OtherNPI