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General NPI Number Information
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NPI Number | 1053545616
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Entity Type | Organization
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Legal Business Name | JOSEPH B. GUARNACCIA, MD, LLC
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 130 DIVISION ST MSTC, C/O GRIFFIN HOSPITAL
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City | DERBY
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State | CT
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Zip | 06418-1326
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Country | US
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Telephone | 203-732-1290
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Fax | 302-732-1299
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Provider Business Mailing Address
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Address Line | 130 DIVISION ST MSTC, C/O GRIFFIN HOSPITAL
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City | DERBY
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State | CT
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Zip | 06418-1326
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Country | US
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Telephone | 203-732-1290
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Fax | 302-732-1299
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. JOSEPH BLAISE GUARNACCIA
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Credential | M.D.
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Telephone | 203-732-1290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 031179
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License Number State | CT
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