Provider Demographics
NPI:1134274921
Name:JOSEPHINE CONTRINO MD, LLC
Entity type:Organization
Organization Name:JOSEPHINE CONTRINO MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-721-9444
Mailing Address - Street 1:78 BEAVER RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2295
Mailing Address - Country:US
Mailing Address - Phone:860-721-9444
Mailing Address - Fax:860-257-3056
Practice Address - Street 1:78 BEAVER RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2295
Practice Address - Country:US
Practice Address - Phone:860-721-9444
Practice Address - Fax:860-257-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6599363LF0000X
CT035532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004206414Medicaid
CT004206414Medicaid