Healthcare Provider Details

I. General information

NPI: 1881635712
Provider Name (Legal Business Name): CONNECTICUT EAR, NOSE & THROAT, SINUS & ALLERGY SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W MAIN ST ONE EXCHANGE PLACE BLDG-3RD FLOOR
WATERBURY CT
06702-2013
US

IV. Provider business mailing address

21 W MAIN ST ONE EXCHANGE PLACE BLDG-3RD FLOOR
WATERBURY CT
06702-2013
US

V. Phone/Fax

Practice location:
  • Phone: 203-574-3777
  • Fax: 203-527-4008
Mailing address:
  • Phone: 203-574-3777
  • Fax: 203-755-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: MS. DANA K. CIPRIANO
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 203-574-3777