Healthcare Provider Details

I. General information

NPI: 1134274921
Provider Name (Legal Business Name): JOSEPHINE CONTRINO MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 BEAVER RD SUITE 1A
WETHERSFIELD CT
06109-2295
US

IV. Provider business mailing address

78 BEAVER RD SUITE 1A
WETHERSFIELD CT
06109-2295
US

V. Phone/Fax

Practice location:
  • Phone: 860-721-9444
  • Fax: 860-257-3056
Mailing address:
  • Phone: 860-721-9444
  • Fax: 860-257-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number035532
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6599
License Number StateCT

VIII. Authorized Official

Name: MRS. ANNA LIS
Title or Position: BILLING
Credential:
Phone: 860-721-9444