Healthcare Provider Details

I. General information

NPI: 1316930951
Provider Name (Legal Business Name): RUSSELL A CIAFONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HIGHRIDGE RD
WEST SIMSBURY CT
06092-2004
US

IV. Provider business mailing address

66 HIGHRIDGE RD
WEST SIMSBURY CT
06092-2004
US

V. Phone/Fax

Practice location:
  • Phone: 860-651-4272
  • Fax:
Mailing address:
  • Phone: 860-651-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number019512
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: