Healthcare Provider Details

I. General information

NPI: 1730177726
Provider Name (Legal Business Name): JOSEPH M. COLASANTO N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE YALE PHYSICIANS BUILDING
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

94 WOODLAND STREET DEPT. OF RADIATION ONCOLOGY
HARTFORD CT
06105
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2140
  • Fax:
Mailing address:
  • Phone: 860-714-4568
  • Fax: 860-714-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number039833
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: