MEDICARE: STATE OF CONNECTICUT OFFICE OF THE COMPTROLLER

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	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861593915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF CONNECTICUT OFFICE OF THE COMPTROLLER

Provider Business Mailing Address
First Line	:	165 CAPITOL AVE
Second Line	:	5TH FLOOR NORTH
City	:	HARTFORD
State	:	CT
Zip	:	06106-1659
Country	:	US
Telephone Number	:	860-713-5399
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 CAPITOL AVE
Second Line	:	5TH FLOOR NORTH
City	:	HARTFORD
State	:	CT
Zip	:	06106-1659
Country	:	US
Telephone Number	:	860-713-5399
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	HENRY JOVANELLY
Credential	:
Telephone Number	:	860-713-5399

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	06/27/2008

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