Healthcare Provider Details

I. General information

NPI: 1760218259
Provider Name (Legal Business Name): RICHARD FICORILLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 BOSTON POST RD STE 201
GUILFORD CT
06437-4360
US

IV. Provider business mailing address

2351 BOSTON POST RD STE 201
GUILFORD CT
06437-4360
US

V. Phone/Fax

Practice location:
  • Phone: 203-506-8294
  • Fax:
Mailing address:
  • Phone: 203-506-8294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: