Healthcare Provider Details

I. General information

NPI: 1588112106
Provider Name (Legal Business Name): EMANUEL COLON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SCIENCE PARK
NEW HAVEN CT
06511-1966
US

IV. Provider business mailing address

60 NEWFIELD AVE
NEW BRITAIN CT
06053-3900
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-8648
  • Fax:
Mailing address:
  • Phone: 860-965-7126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: