Provider Demographics
NPI:1659565901
Name:DIDOMIZIO HEALTH & REHABILITATION
Entity Type:Organization
Organization Name:DIDOMIZIO HEALTH & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIDOMIZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-879-4695
Mailing Address - Street 1:444 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2639
Mailing Address - Country:US
Mailing Address - Phone:203-879-4695
Mailing Address - Fax:
Practice Address - Street 1:444 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2639
Practice Address - Country:US
Practice Address - Phone:203-879-4695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT525261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty