Healthcare Provider Details

I. General information

NPI: 1700675790
Provider Name (Legal Business Name): FIREPIT HEALTH MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ELM ST STE 1L
NEW HAVEN CT
06510-2023
US

IV. Provider business mailing address

14 ALEWIVE BROOK RD
EAST HAMPTON NY
11937-1190
US

V. Phone/Fax

Practice location:
  • Phone: 203-689-0850
  • Fax: 888-830-3669
Mailing address:
  • Phone: 203-689-0850
  • Fax: 888-830-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HAMILTON GAIANI
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 203-689-0850