Healthcare Provider Details

I. General information

NPI: 1790796647
Provider Name (Legal Business Name): MICHAEL CORJULO C.P.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 WASHINGTON AVE STE LL
HAMDEN CT
06518-3039
US

IV. Provider business mailing address

299 WASHINGTON AVE
HAMDEN CT
06518-3026
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-4288
  • Fax: 203-288-1566
Mailing address:
  • Phone: 203-288-4288
  • Fax: 203-288-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number002019
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: