Healthcare Provider Details

I. General information

NPI: 1548628183
Provider Name (Legal Business Name): NICHOLAS L PINTAURO N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MIX AVE APT 6K
HAMDEN CT
06514-2320
US

IV. Provider business mailing address

630 MIX AVE APT 6K
HAMDEN CT
06514-2320
US

V. Phone/Fax

Practice location:
  • Phone: 631-252-4084
  • Fax:
Mailing address:
  • Phone: 631-252-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000531
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: