Healthcare Provider Details

I. General information

NPI: 1548405871
Provider Name (Legal Business Name): HUSEYIN NAIL AYDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FOUNDERS ST STE 102
WILLIMANTIC CT
06226-2050
US

IV. Provider business mailing address

5 FOUNDERS ST STE 102
WILLIMANTIC CT
06226-2050
US

V. Phone/Fax

Practice location:
  • Phone: 203-907-7227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberQ3143
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberQ3143
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number01066208A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number57208
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: