Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 179518 | NY |
Y | 2086S0102X | Surgical Critical Care | 36193 | CT |
NPI | 1285611178 |
---|---|
Provider Name | Dr. Jeffrey M. Nicastro |
First Address | Danbury, CT 06810-6000 |
Second Address | Danbury, CT 06810-6000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 04/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01867858 | (05) | NY |
G71727 | (02) | NY |