Provider Demographics
NPI:1023717527
Name:GISNARIAN, CARL JOSEPH (CCP, LP)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:JOSEPH
Last Name:GISNARIAN
Suffix:
Gender:M
Credentials:CCP, LP
Other - Prefix:
Other - First Name:CARL
Other - Middle Name:JOSEPH
Other - Last Name:GISNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2712
Mailing Address - Country:US
Mailing Address - Phone:860-790-3517
Mailing Address - Fax:
Practice Address - Street 1:29 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2712
Practice Address - Country:US
Practice Address - Phone:860-790-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
099034OtherAMERICAN BOARD OF CARDIOVASCULAR PERFUSION
CT83.000131OtherLICENSURE