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General NPI Number Information
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NPI Number | 1326331471
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Entity Type | Organization
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Legal Business Name | CIRCULATORY CENTERS CONNECTICUT, LLC
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 4 HUNTLEY RD SUITE 1
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City | OLD LYME
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State | CT
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Zip | 06371-1449
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Country | US
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Telephone | 860-434-4073
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Fax | 860-434-4635
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Provider Business Mailing Address
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Address Line | 397 CHURCHILL HUBBARD RD
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City | YOUNGSTOWN
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State | OH
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Zip | 44505-1375
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Country | US
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Telephone | 330-759-6750
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Fax | 330-759-6755
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LOUIS MICHAEL CERTO
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Credential | M.D.
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Telephone | 412-967-9220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 005169
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 039899
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License Number State | CT
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