Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 49814 | CT |
NPI | 1013971316 |
---|---|
Provider Name | Randall J Risinger |
First Address | Rocky Hill, CT 06067-3455 |
Second Address | Manchester, CT 06040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9002536 | (05) | RI |
I20674 | (02) | RI |