Provider Demographics
NPI:1811186679
Name:FRANCIS J FORNO JR DO, LLC
Entity Type:Organization
Organization Name:FRANCIS J FORNO JR DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:FORNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-364-1936
Mailing Address - Street 1:172 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1443
Mailing Address - Country:US
Mailing Address - Phone:203-364-1936
Mailing Address - Fax:203-364-0839
Practice Address - Street 1:172 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1443
Practice Address - Country:US
Practice Address - Phone:203-364-1936
Practice Address - Fax:203-364-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTDO2388Medicare PIN
CTC03353Medicare PIN