Provider Demographics
NPI:1093366924
Name:BALSAMO, GAETANO
Entity Type:Individual
Prefix:
First Name:GAETANO
Middle Name:
Last Name:BALSAMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 ELM MDWS
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3062
Mailing Address - Country:US
Mailing Address - Phone:860-305-0577
Mailing Address - Fax:
Practice Address - Street 1:188 POST OFFICE RD UNIT 1
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5686
Practice Address - Country:US
Practice Address - Phone:860-305-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider