Healthcare Provider Details

I. General information

NPI: 1144314311
Provider Name (Legal Business Name): GEOFFREY E FERRUCCI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST 6TH FLOOR
WATERBURY CT
06708-2613
US

IV. Provider business mailing address

1625 STRAITS TPKE SUITE #301
MIDDLEBURY CT
06762-1836
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6263
  • Fax: 203-573-6707
Mailing address:
  • Phone: 203-573-9512
  • Fax: 203-568-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001464
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: