Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 031537 | CT |
NPI | 1023112596 |
---|---|
Provider Name | John Russomanno |
First Address | Rocky Hill, CT 06067-2313 |
Second Address | Hartford, CT 06106-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 08/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00131537500 | (05) | CT |
E86201 | (02) | CT |