Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 000278 | CT |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 167000 | NY |
N | 207Q00000X | Family Doctor | 000278 | CT |
N | 207Q00000X | Family Doctor | 167000 | NY |
NPI | 1184747305 |
---|---|
Provider Name | Dr. Domenick John Masiello |
First Address | Ridgefield, CT 06877-2335 |
Second Address | Ridgefield, CT 06877-2335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 13/09/2016 |