Doctor Name: | VICTOR EANNIELLO |
NPI Number: | 1174577688 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 031823 |
Business Practice Address: | 201 Chestnut Hill Rd Stafford Springs, CT - 060769925 |
Business Phone Number: | 8606848424 |
Business Fax Number: | 8606848460 |
Mailing Address: | 99 East River Drive, EAST HARTFORD |
State: | CT |
Postal Code: | 06108 |
Phone Number: | 8606848424 |
Fax Number: | 8606848460 |
NPI Enumeration Date: | 05/20/2006 |
NPI Last Update Date: | 10/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 031823 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CT |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |