Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 000627 | CT |
Y | 111NN0400X | Neurology | 627 | CT |
NPI | 1003018292 |
---|---|
Provider Name | Mr. Michael Robert Barone JR. |
First Address | North Haven, CT 06473-3039 |
Second Address | Hamden, CT 06514-3147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 07/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U74760 | (02) | CT |