Provider Demographics
NPI:1679819932
Name:SCAFURI, LARRY PAUL
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:PAUL
Last Name:SCAFURI
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 1:704 WOODGATE CIR
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5582
Mailing Address - Country:US
Mailing Address - Phone:413-478-5417
Mailing Address - Fax:
Practice Address - Street 1:300 BIRNIE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1107
Practice Address - Country:US
Practice Address - Phone:413-230-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8430261QA1903X
CT001019313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility