Provider Demographics
NPI:1639295504
Name:ARMENTANO, MICHAEL
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:ARMENTANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BRINSMADE LN
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:CT
Mailing Address - Zip Code:06784-1434
Mailing Address - Country:US
Mailing Address - Phone:203-637-8464
Mailing Address - Fax:203-413-6303
Practice Address - Street 1:296 SOUND BEACH AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1626
Practice Address - Country:US
Practice Address - Phone:203-637-8464
Practice Address - Fax:203-413-6303
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000287175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110000287CT01OtherANTHEM PROVIDER ID
CT028700OtherCONNECTICARE PROVIDER ID