Healthcare Provider Details

I. General information

NPI: 1659567352
Provider Name (Legal Business Name): ALYSSA GILLEGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 LAFAYETTE PL STE 302
GREENWICH CT
06830-5426
US

IV. Provider business mailing address

PO BOX 415126
BOSTON MA
02241-5126
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-4250
  • Fax: 203-863-4249
Mailing address:
  • Phone: 203-863-4250
  • Fax: 203-863-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number252073
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number056739
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: