Provider Demographics
NPI:1366449324
Name:FANELLA, FRANK JR (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:FANELLA
Suffix:JR
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3252
Mailing Address - Country:US
Mailing Address - Phone:860-355-2625
Mailing Address - Fax:
Practice Address - Street 1:120 PARK LN
Practice Address - Street 2:SUITE A-101
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2428
Practice Address - Country:US
Practice Address - Phone:860-355-8190
Practice Address - Fax:860-355-3856
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035965208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics