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General NPI Number Information
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NPI Number | 1144314311
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Entity Type | Individual
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Provider Name | GEOFFREY E FERRUCCI PA
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 64 ROBBINS ST 6TH FLOOR
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City | WATERBURY
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State | CT
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Zip | 06708-2613
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Country | US
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Telephone | 203-573-6263
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Fax | 203-573-6707
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Provider Business Mailing Address
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Address Line | 1625 STRAITS TPKE SUITE #301
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City | MIDDLEBURY
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State | CT
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Zip | 06762-1836
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Country | US
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Telephone | 203-573-9512
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Fax | 203-568-2904
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001464
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License Number State | CT
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