Healthcare Provider Details

I. General information

NPI: 1619819992
Provider Name (Legal Business Name): CONNECTICUT ENT ALLERGY & SINUS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 GRANDVIEW AVE STE 201
WATERBURY CT
06708-2520
US

IV. Provider business mailing address

171 GRANDVIEW AVE STE 201
WATERBURY CT
06708-2520
US

V. Phone/Fax

Practice location:
  • Phone: 203-578-4630
  • Fax: 203-578-4629
Mailing address:
  • Phone: 203-578-4630
  • Fax: 203-578-4629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND E WINICKI
Title or Position: MANAGING PARTNER
Credential:
Phone: 203-578-4630