Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 034143 | CT |
N | 207VG0400X | Gynecologist | 034143 | CT |
N | 207VX0000X | Obstetrician | 034143 | CT |
NPI | 1285668350 |
---|---|
Provider Name | Anita Petruzzelli |
First Address | Cheshire, CT 06410 |
Second Address | Cheshire, CT 06410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 30/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F93643 | (02) |