Healthcare Provider Details

I. General information

NPI: 1700889094
Provider Name (Legal Business Name): ROBERT J PATRIGNELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

965 WHITE PLAINS RD
TRUMBULL CT
06611-4566
US

IV. Provider business mailing address

965 WHITE PLAINS RD
TRUMBULL CT
06611-4566
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-0800
  • Fax: 203-268-2668
Mailing address:
  • Phone: 203-261-0800
  • Fax: 203-268-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number033309
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: