Healthcare Provider Details

I. General information

NPI: 1194495705
Provider Name (Legal Business Name): EDWARD PINUNSKY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BRITTANY FARMS RD
NEW BRITAIN CT
06053-1154
US

IV. Provider business mailing address

233 FARMSTEAD RD
SOUTHINGTON CT
06489-2461
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-3111
  • Fax:
Mailing address:
  • Phone: 860-305-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9878
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: