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General NPI Number Information
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NPI Number | 1700983442
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Entity Type | Organization
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Legal Business Name | JOSEPH T ANQUILLARE, MD, LLC
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 28 FIELDSTONE PATH
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City | NEWINGTON
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State | CT
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Zip | 06111-4631
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Country | US
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Telephone | 860-306-9734
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Fax | 860-667-0695
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Provider Business Mailing Address
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Address Line | 28 FIELDSTONE PATH
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City | NEWINGTON
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State | CT
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Zip | 06111-4631
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Country | US
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Telephone | 860-306-9734
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Fax | 860-667-0695
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. JOSEPH T ANQUILLARE SR.
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Credential | M.D.
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Telephone | 860-306-9733
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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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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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Taxonomy #5
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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