MEDICARE: DR. HELENA T SQUICCIARINI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	237733	NY
2	207V00000X	Obstetrics & Gynecology Physician	049283	CT

General Provider Information

NPI Number	:	1487691754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HELENA T SQUICCIARINI D.O.

Provider Business Mailing Address
First Line	:	5520 PARK AVE
Second Line	:	SUITE 302
City	:	TRUMBULL
State	:	CT
Zip	:	06611-3463
Country	:	US
Telephone Number	:	203-374-1018
Fax Number	:	203-396-0699

Provider Business Practice Location Address
First Line	:	5520 PARK AVE
Second Line	:	SUITE 302
City	:	TRUMBULL
State	:	CT
Zip	:	06611-3463
Country	:	US
Telephone Number	:	203-374-1018
Fax Number	:	203-396-0699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	11/17/2010

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