Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 050338 | CT |
NPI | 1306116389 |
---|---|
Provider Name | Dr. Jose Manuel Panisello |
First Address | New Haven, CT 06520-8064 |
Second Address | New Haven, CT 06510-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2012 |
Last Update Date | 05/04/2012 |