Provider Demographics
NPI:1992003792
Name:ANITA PETRUZZELLI MD PC
Entity Type:Organization
Organization Name:ANITA PETRUZZELLI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUZZELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-959-2758
Mailing Address - Street 1:701 HEBRON AVE
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2489
Mailing Address - Country:US
Mailing Address - Phone:800-959-2758
Mailing Address - Fax:
Practice Address - Street 1:701 HEBRON AVE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2489
Practice Address - Country:US
Practice Address - Phone:800-959-2758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty