Healthcare Provider Details

I. General information

NPI: 1144305079
Provider Name (Legal Business Name): JOSEPH E STRUCKUS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAIN STREET
NEW PRESTON CT
06777-2219
US

IV. Provider business mailing address

10 MAIN STREET P.O. BOX 2219
NEW PRESTON CT
06777-2219
US

V. Phone/Fax

Practice location:
  • Phone: 860-868-9000
  • Fax: 860-868-0055
Mailing address:
  • Phone: 860-868-9000
  • Fax: 860-868-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number001640
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: