Healthcare Provider Details

I. General information

NPI: 1528114758
Provider Name (Legal Business Name): WALSH-BRUNETTI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 RIVER RD SUITE 200
COS COB CT
06807-2152
US

IV. Provider business mailing address

31 RIVER RD SUITE 200
COS COB CT
06807-2152
US

V. Phone/Fax

Practice location:
  • Phone: 203-661-9433
  • Fax: 203-661-2918
Mailing address:
  • Phone: 203-661-9433
  • Fax: 203-661-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: JENNIFER THORNLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 203-661-9439