Healthcare Provider Details

I. General information

NPI: 1720003742
Provider Name (Legal Business Name): RICHARD JOSEPH RESTIFO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 ELM ST SUITE 560
NEW HAVEN CT
06510-2047
US

IV. Provider business mailing address

59 ELM ST SUITE 560
NEW HAVEN CT
06510-2047
US

V. Phone/Fax

Practice location:
  • Phone: 203-772-1444
  • Fax: 203-907-0503
Mailing address:
  • Phone: 203-772-1444
  • Fax: 203-907-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number033015
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: