Healthcare Provider Details

I. General information

NPI: 1992725238
Provider Name (Legal Business Name): JASON M. CITARELLA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 MONROE TPKE
MONROE CT
06468-2343
US

IV. Provider business mailing address

450 MONROE TPKE
MONROE CT
06468-2343
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-2525
  • Fax: 203-459-0396
Mailing address:
  • Phone: 203-261-2525
  • Fax: 203-459-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number000547
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: