Provider Demographics
NPI:1376640672
Name:FONG-BRETON, JOYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:FONG-BRETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PALOMBA DR
Mailing Address - Street 2:SUITE 13
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3888
Mailing Address - Country:US
Mailing Address - Phone:860-749-2251
Mailing Address - Fax:860-745-7747
Practice Address - Street 1:15 PALOMBA DR
Practice Address - Street 2:SUITE 13
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3888
Practice Address - Country:US
Practice Address - Phone:860-749-2251
Practice Address - Fax:860-745-7747
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037874208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH03472Medicare UPIN