Healthcare Provider Details

I. General information

NPI: 1447433677
Provider Name (Legal Business Name): FIGNAR FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PALOMBA DR SUITE 5
ENFIELD CT
06082-3888
US

IV. Provider business mailing address

15 PALOMBA DR SUITE 5
ENFIELD CT
06082-3888
US

V. Phone/Fax

Practice location:
  • Phone: 860-745-1623
  • Fax: 860-741-3618
Mailing address:
  • Phone: 860-745-1623
  • Fax: 860-741-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number040711
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002009
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001809
License Number StateCT

VIII. Authorized Official

Name: DR. TIMOTHY ALAN FIGNAR
Title or Position: OWNER
Credential: M.D.
Phone: 860-745-1623