Provider Demographics
NPI:1508176272
Name:HARRY ARDOLINO, M.D., LLC
Entity Type:Organization
Organization Name:HARRY ARDOLINO, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-481-8444
Mailing Address - Street 1:21 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2935
Mailing Address - Country:US
Mailing Address - Phone:203-481-8444
Mailing Address - Fax:203-483-0176
Practice Address - Street 1:21 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2935
Practice Address - Country:US
Practice Address - Phone:203-481-8444
Practice Address - Fax:203-483-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOV9368OtherHEALTHNET
CT010024308CT02OtherANTHEM
024308OtherCONNECTICARE
CT2652425OtherAETNA
CT0133567003OtherCIGNA
CTOV9368OtherHEALTHNET
CT010024308CT02OtherANTHEM