Healthcare Provider Details

I. General information

NPI: 1902964414
Provider Name (Legal Business Name): JOSEPH ALESSANDRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CANTERBURY RD
BROOKLYN CT
06234-1901
US

IV. Provider business mailing address

63 CANTERBURY RD
BROOKLYN CT
06234-1901
US

V. Phone/Fax

Practice location:
  • Phone: 860-779-5940
  • Fax: 860-779-5499
Mailing address:
  • Phone: 860-779-5940
  • Fax: 860-779-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number000477
License Number StateCT

VIII. Authorized Official

Name: BRENDA D KOSKI
Title or Position: BILLING
Credential:
Phone: 860-779-5940