Healthcare Provider Details

I. General information

NPI: 1558208017
Provider Name (Legal Business Name): MICHAEL MCGONNIGLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 HAYNES ST
MANCHESTER CT
06040-4188
US

IV. Provider business mailing address

38 LORDSHIP RD
STRATFORD CT
06615-7820
US

V. Phone/Fax

Practice location:
  • Phone: 860-533-4679
  • Fax: 860-645-4151
Mailing address:
  • Phone: 203-885-4432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: