Healthcare Provider Details

I. General information

NPI: 1376560813
Provider Name (Legal Business Name): JOSEPH A CAMILLERI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WASHINGTON AVE
HAMDEN CT
06518-3267
US

IV. Provider business mailing address

67 MAPLE AVE
DERBY CT
06418-1328
US

V. Phone/Fax

Practice location:
  • Phone: 475-227-3614
  • Fax:
Mailing address:
  • Phone: 203-732-1330
  • Fax: 203-732-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number031232
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: