Healthcare Provider Details

I. General information

NPI: 1992630115
Provider Name (Legal Business Name): KENNETH EUGENE CASELNOVA III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 DANBURY RD
RIDGEFIELD CT
06877-4069
US

IV. Provider business mailing address

9 CLOVERLEAF DR
NEW FAIRFIELD CT
06812-3120
US

V. Phone/Fax

Practice location:
  • Phone: 203-587-7194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: