Healthcare Provider Details

I. General information

NPI: 1164463469
Provider Name (Legal Business Name): WILLIAM J. AQUILA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LOCK STREET
NEW HAVEN CT
06520-8237
US

IV. Provider business mailing address

PO BOX 208237 55 LOCK STREET
NEW HAVEN CT
06520-8237
US

V. Phone/Fax

Practice location:
  • Phone: 203-432-0076
  • Fax: 203-432-7289
Mailing address:
  • Phone: 203-432-0076
  • Fax: 203-432-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000559
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: