Healthcare Provider Details

I. General information

NPI: 1326509506
Provider Name (Legal Business Name): JOHN SIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVE STE 300
HAMDEN CT
06518-3602
US

IV. Provider business mailing address

87 GRANDVIEW AVE STE B
WATERBURY CT
06708-2514
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-2020
  • Fax: 203-288-2470
Mailing address:
  • Phone: 203-574-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number73903
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: