Healthcare Provider Details

I. General information

NPI: 1629782180
Provider Name (Legal Business Name): GV MEDICAL PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FARMINGTON AVE BLDG B2ND
PLAINVILLE CT
06062-1700
US

IV. Provider business mailing address

17 FARMINGTON AVE BLDG B2ND
PLAINVILLE CT
06062-1700
US

V. Phone/Fax

Practice location:
  • Phone: 203-536-6274
  • Fax: 888-417-4305
Mailing address:
  • Phone: 860-351-5528
  • Fax: 888-417-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD VALETTA
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 860-351-5528