Provider Demographics
NPI:1457388183
Name:FORGIONE-RUBINO, LAUREEN (MD)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:
Last Name:FORGIONE-RUBINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 MAIN STREET
Mailing Address - Street 2:SUITE #105
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-645-1232
Mailing Address - Fax:860-647-0438
Practice Address - Street 1:945 MAIN STREET
Practice Address - Street 2:SUITE #105
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-645-1232
Practice Address - Fax:860-647-0438
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033061208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
010033061CT01OtherBCBS
CT004249810Medicaid
CT004249810Medicaid
CT020001412Medicare PIN