Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 740 | CT |
NPI | 1679679542 |
---|---|
Provider Name | Dr. Alexander J. Salustri JR. |
First Address | Mansfield Center, CT 06250-1200 |
Second Address | Mansfield Center, CT 06250-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
413424300 | (05) | CT |
T88944 | (02) | CT |