Healthcare Provider Details

I. General information

NPI: 1740527365
Provider Name (Legal Business Name): JOSEPH ALESSANDRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WESTCOTT RD
DANIELSON CT
06239-2929
US

IV. Provider business mailing address

PO BOX 6
POMFRET CENTER CT
06259-0006
US

V. Phone/Fax

Practice location:
  • Phone: 860-774-9540
  • Fax:
Mailing address:
  • Phone: 860-455-6410
  • Fax: 800-208-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000477
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number000477
License Number StateCT

VIII. Authorized Official

Name: DR. JOSEPH ALESSANDRO
Title or Position: OWNER
Credential: DO
Phone: 860-455-6410