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General NPI Number Information
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NPI Number | 1902900525
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Entity Type | Individual
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Provider Name | JOSEPH L IANELLO MD
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Gender | Male
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 113 ELM ST STE 303
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City | ENFIELD
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State | CT
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Zip | 06082-3739
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Country | US
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Telephone | 860-253-6867
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Fax | 860-741-4399
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Provider Business Mailing Address
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Address Line | 30 WATERCHASE DR
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City | ROCKY HILL
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State | CT
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Zip | 06067-2110
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Country | US
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Telephone | 860-257-4131
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Fax | 860-257-4519
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 031644
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License Number State | CT
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