Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 261Q00000X | Clinic/Center | | 0000610 | CONNECTICUT | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 008003745 | OTHER | CONNECTICUT | DESROSIERS MEDICAID |
| 2 | D400318431 | MEDICARE PIN | CONNECTICUT | |
| 3 | 004217099 | OTHER | CONNECTICUT | PCS LONG WHARF MEDICAID |
| 4 | 008053091 | OTHER | CONNECTICUT | BUTNER MEDICAID |
| 5 | 008040283 | OTHER | CONNECTICUT | CAMENGA MEDICAID |
| 6 | C01033 | MEDICARE PIN | CONNECTICUT | |
| 7 | D400278647 | MEDICARE PIN | CONNECTICUT | |
| 8 | D400318461 | MEDICARE PIN | CONNECTICUT | |
| 9 | D400344291 | MEDICARE PIN | CONNECTICUT | |
| 10 | 001302497 | OTHER | CONNECTICUT | SHI MEDICAID |
| 11 | 440000058 | MEDICARE PIN | CONNECTICUT | |
| 12 | 001218107 | OTHER | CONNECTICUT | SCHOTTENFELD MEDICAID |
| 13 | 008058058 | OTHER | CONNECTICUT | SADINSKY MEDICAID |
| 14 | 001307439 | OTHER | CONNECTICUT | ALTICE MEDICAID |
| 15 | 110003899 | MEDICARE PIN | CONNECTICUT | |
| 16 | D400083844 | MEDICARE PIN | CONNECTICUT | |
| 17 | D400278702 | MEDICARE PIN | CONNECTICUT | |
| 18 | D400316058 | MEDICARE PIN | CONNECTICUT | |
| 19 | 008069118 | OTHER | CONNECTICUT | CAMPBELL MEDICAID # |
| 20 | 110004627 | MEDICARE PIN | CONNECTICUT | |
| 21 | D400315836 | MEDICARE PIN | CONNECTICUT | |
| 22 | D400318773 | MEDICARE PIN | CONNECTICUT | |
| 23 | 008066948 | OTHER | CONNECTICUT | LOUIE MEDICAID |
| 24 | D400346532 | MEDICARE PIN | CONNECTICUT | |
| 25 | D400081097 | MEDICARE PIN | CONNECTICUT | |
| 26 | 008068420 | OTHER | CONNECTICUT | SCHEFILITI MEDICAID |
| 27 | 008066801 | OTHER | CONNECTICUT | HAQUE MEDICAID |
| 28 | 001423135 | OTHER | CONNECTICUT | TETRAULT MEDICAID |
| 29 | 008066315 | OTHER | CONNECTICUT | COLON RIVERA MEDICAID |
| 30 | 008063396 | OTHER | CONNECTICUT | MEMISEVICH MEDICAID |
| 31 | D400082725 | MEDICARE PIN | CONNECTICUT | |
| 32 | D400172220 | MEDICARE PIN | CONNECTICUT | |
| 33 | D400076510 | MEDICARE PIN | CONNECTICUT | |
| 34 | 008066293 | OTHER | CONNECTICUT | MARDAM BEY MEDICAID |
| 35 | 001340132 | OTHER | CONNECTICUT | SAVAGE MEDICAID |
| 36 | 008037391 | OTHER | CONNECTICUT | SHACKELL MEDICAID |
| 37 | 001272286 | MEDICAID | CONNECTICUT | |
