Healthcare Provider Details

I. General information

NPI: 1649780479
Provider Name (Legal Business Name): MIDDLESEX HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SAYBROOK RD STE N100
MIDDLETOWN CT
06457-4741
US

IV. Provider business mailing address

520 SAYBROOK RD STE N100
MIDDLETOWN CT
06457-4741
US

V. Phone/Fax

Practice location:
  • Phone: 860-344-1801
  • Fax: 860-358-8657
Mailing address:
  • Phone: 860-358-6394
  • Fax: 860-358-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: VINCENT G CAPECE
Title or Position: CEO
Credential:
Phone: 860-358-6150