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General NPI Number Information
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NPI Number | 1275627093
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Entity Type | Organization
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Legal Business Name | DR. PHILIP A. MONGELLUZZO, JR. LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 2247 EAST MAIN STREET
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City | WATERBURY
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State | CT
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Zip | 06705
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Country | US
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Telephone | 203-757-3486
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Fax | 203-757-4376
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Provider Business Mailing Address
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Address Line | 93 HEMPEL DRIVE
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City | WOLCOTT
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State | CT
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Zip | 06716
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Country | US
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Telephone | 203-757-3486
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP A. MONGELLUZZO JR.
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Credential | M.D.
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Telephone | 203-757-3486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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