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General NPI Number Information
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NPI Number | 1962743872
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Entity Type | Individual
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Provider Name | LINDSEY RONCAIOLI P.A
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Gender | Female
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 320 WESTERN BLVD SUITE 104
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City | GLASTONBURY
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State | CT
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Zip | 06033-1259
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Country | US
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Telephone | 860-657-5940
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Fax |
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Provider Business Mailing Address
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Address Line | 3 DANIEL ST
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City | EAST HAMPTON
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State | CT
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Zip | 06424-1806
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Country | US
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Telephone | 860-748-7312
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003422
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA4655
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License Number State | MA
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