Healthcare Provider Details

I. General information

NPI: 1265992309
Provider Name (Legal Business Name): J CHRISTIAN BELISARIO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 LONG RIDGE RD
STAMFORD CT
06902-1638
US

IV. Provider business mailing address

47 COLLEGE ST FL 2
NEW HAVEN CT
06510-3209
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-5461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number79380
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: