Provider Demographics
NPI:1609880434
Name:NINIVAGGI, FRANK JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JOHN
Last Name:NINIVAGGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 LAMBERT ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-1805
Mailing Address - Country:US
Mailing Address - Phone:203-789-8753
Mailing Address - Fax:
Practice Address - Street 1:200 ORCHARD STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-789-8753
Practice Address - Fax:860-868-6711
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT177092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001177096Medicaid
B83921Medicare UPIN