Provider Demographics
NPI:1831101229
Name:GRIMALDI, STEPHEN N (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:N
Last Name:GRIMALDI
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Gender:M
Credentials:DO
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Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:622 HEBRON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2421
Practice Address - Country:US
Practice Address - Phone:860-657-4080
Practice Address - Fax:860-659-3110
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-06-20
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Provider Licenses
StateLicense IDTaxonomies
CT000263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE07622Medicare UPIN