Provider Demographics
NPI:1922296110
Name:EDWARD C. CORSELLO D.C. L.L.C
Entity Type:Organization
Organization Name:EDWARD C. CORSELLO D.C. L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CORSELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-381-1800
Mailing Address - Street 1:3333 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4861
Mailing Address - Country:US
Mailing Address - Phone:203-381-1800
Mailing Address - Fax:203-381-1801
Practice Address - Street 1:3333 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4861
Practice Address - Country:US
Practice Address - Phone:203-381-1800
Practice Address - Fax:203-381-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001562111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCV9313OtherHEALTHNET PROVIDER ID
CTP3570853OtherOXFORD ID
CT06105OtherCT CARE PAYER ID
CT050001562CT04OtherANTHEM PROVIDER ID