Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 031112 | CT |
Y | 111NI0900X | Internist | 031112 | CT |
N | 207RI0200X | Infectious Disease | 031112 | CT |
NPI | 1083693022 |
---|---|
Provider Name | Dr. Kenneth Abriola |
First Address | Glastonbury, CT 06033-2176 |
Second Address | Glastonbury, CT 06033-2176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 05/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E54785 | (02) | CT |