Provider Demographics
NPI:1508211335
Name:REALE, ANTONIO (ND)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:REALE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3125
Mailing Address - Country:US
Mailing Address - Phone:860-748-6624
Mailing Address - Fax:
Practice Address - Street 1:135 MAIN ST
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3125
Practice Address - Country:US
Practice Address - Phone:860-748-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5.000567175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath