Provider Demographics
NPI:1679686844
Name:NARDECCHIA, ANTHONY A (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:NARDECCHIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 SAVIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4901
Mailing Address - Country:US
Mailing Address - Phone:203-932-0600
Mailing Address - Fax:203-932-0578
Practice Address - Street 1:666 SAVIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4901
Practice Address - Country:US
Practice Address - Phone:203-932-0600
Practice Address - Fax:203-932-0578
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP3492577OtherOXFORD PROVIDER ID
CT050001447CT02OtherANTHEM PROVIDER ID
CT680886OtherCONNECTICARE PROVIDER ID
CT001447OtherLANDMARK PROVIDER ID
CTU88937Medicare UPIN