Healthcare Provider Details

I. General information

NPI: 1740298322
Provider Name (Legal Business Name): GARY THOMAS YACONO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 STATE ROUTE 37
NEW FAIRFIELD CT
06812-4013
US

IV. Provider business mailing address

130 STATE ROUTE 37
NEW FAIRFIELD CT
06812-4013
US

V. Phone/Fax

Practice location:
  • Phone: 203-746-6000
  • Fax: 203-746-0155
Mailing address:
  • Phone: 203-746-6000
  • Fax: 203-746-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number026624
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: