MYSTIC GERIATRICS, LLC (NPI# 1336167238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336167238 |
| Entity Type | Organization |
| Organization Name | MYSTIC GERIATRICS, LLC |
| Practice Address |
3 Heron Rd Mystic CT 06355-3253 |
| Practice Telephone | 8605365302 |
| Practice Fax Number | 8605365302 |
| Mailing Telephone | 8605365302 |
| Mailing Fax Number | 8605365302 |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2015-07-20 |
| Authorized Official Name | MS. JUNE FLIRI (MANAGER) |
| Authorized Official Telephone | 8605368882 |
| Authorized Official Credential | M.B.A., M.S.W. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
3 HERON RD |
| City | MYSTIC |
| State | CT |
| Zip Code | 06355-3253 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730182353 | Cheryl A Walker | Nurse Practitioner | 3 Heron Rd, Mystic, CT 06355-3253 | 2005-05-27 |
| 1245616705 | Karen Janet Terwilliger | Nurse Practitioner | 3 Heron Rd, Mystic, CT 06355-3253 | 2015-08-07 |
| 1679628820 | Michael J. Feltes, Dba Sound Seniors Geriatrics, Md | Internal Medicine | 3 Heron Rd, Mystic, CT 06355-3253 | 2007-01-25 |
| 1588719736 | Michael J. Feltes,dba Sound Seniors Geriatrics, Aprn | Nurse Practitioner | 3 Heron Rd, Mystic, CT 06355-3253 | 2007-01-25 |
| 1689690216 | Michael J Feltes | Family Medicine | 3 Heron Rd, Mystic, CT 06355-3253 | 2006-07-15 |
| 1114943214 | Mary Ellen Pagnozzi | Nurse Practitioner | 3 Heron Rd, Mystic, CT 06355-3253 | 2006-07-14 |
| 1124026869 | Harold E Phillips Jr. | Family Medicine | 3 Heron Rd, Mystic, CT 06355-3253 | 2005-07-07 |
| 1457357618 | Judy D Mamaclay | Internal Medicine | 3 Heron Rd, Mystic, CT 06355-3253 | 2005-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770076069 | Brian Kristofer Owczarski | Physical Therapist | 80 Stonington Rd Ste A-3, Mystic, CT 06355 | 2018-06-11 |
| 1922554120 | Kayla Nickerson Gauthier | Marriage & Family Therapist | 41 Williams Ave, Mystic, CT 06355 | 2016-08-28 |
| 1417351156 | Lisa Pacifico | Physical Therapist | 44 Maritime Dive, Mystic, CT 06355 | 2014-10-09 |
| 1619386539 | Jennifer Rock | Occupational Therapist | 44 Maritime Drive, Pendleton Health and Rehab Center, Mystic, CT 06355 | 2014-08-05 |
| 1346565843 | Karen Lucille Hanscom | Psychologist | 47 Water St. #203, Mystic, CT 06355 | 2010-03-29 |
| 1346415627 | Eldon Richard Kilpatrick | Physical Therapy Assistant | 186 Jerry Browne Rd, Mystic, CT 06355 | 2008-04-28 |
| 1760688931 | Heather Elyse Geyer | Physical Therapist | 2440 Gold Star Hwy Suite 201, Mystic, CT 06355 | 2007-06-25 |
| 1982728754 | Falck Eye Center LLC | Ophthalmology | 35 Washington Street, Mystic, CT 06355 | 2007-03-19 |
| 1881724326 | Richard Irwin Steinberg | Dentist | 117 Cow Hill Road, Mystic, CT 06355 | 2007-03-06 |
| 1992890362 | Coastal Dermatology, P.C. | Dermatology | 55 Willow Street, Mystic, CT 06355 | 2006-10-03 |
| Find all providers in zip 06355 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033214358 | Walter Michael Kobialka | Family Medicine | 1275 Summer St Ste 102, Stamford, CT 06905-5315 | 2006-09-13 |
| 1154323426 | Rohini Ruth Becherl | Family Medicine | 80 Seymour Street, Hartford Hospital Geriatrics Program, Hartford, CT 06102-5037 | 2005-06-01 |
| 1184112203 | He Sun | Family Medicine | 20 York St, New Haven, CT 06510-3220 | 2018-04-24 |
| 1609001551 | Maggie Hsin-i Lee | Family Medicine | 1354 Chapel St, New Haven, CT 06511-4420 | 2009-05-21 |
| 1093952194 | Matthew Raider Md LLC | Family Medicine | 645 Saybrook Rd, Middletown, CT 06457-4746 | 2009-01-11 |
| 1508082561 | Maria Lementowska | Family Medicine | 1461 South Britain Rd, Southbury, CT 06488-0901 | 2007-04-18 |
| 1841340445 | Daniel Rissi | Family Medicine | 365 Montauk Ave, New London, CT 06320-4700 | 2007-01-12 |
| 1881776060 | Aarthi Anand | Family Medicine | 805 Atlantic St, Stamford, CT 06902-6805 | 2006-10-19 |
| 1982647095 | John Augustus Merritt Jr. | Family Medicine | 1450 Chapel St, New Haven, CT 06511 | 2006-06-14 |
| 1851350664 | Middlesex Hospital | Family Medicine | 90 S Main St, Middletown, CT 06457-3649 | 2006-03-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.