Healthcare Provider Details

I. General information

NPI: 1134121429
Provider Name (Legal Business Name): ALFONSO R ENRIQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 KENSINGTON AVE
NEW BRITAIN CT
06051-3916
US

IV. Provider business mailing address

300 KENSINGTON AVE
NEW BRITAIN CT
06051-3916
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-6282
  • Fax: 860-826-4959
Mailing address:
  • Phone: 860-224-6282
  • Fax: 860-826-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number014039
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: