Provider Demographics
NPI:1700983442
Name:JOSEPH T ANQUILLARE, MD, LLC
Entity Type:Organization
Organization Name:JOSEPH T ANQUILLARE, MD, LLC
Other - Org Name:GERIATRIC HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANQUILLARE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:860-306-9733
Mailing Address - Street 1:28 FIELDSTONE PATH
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4631
Mailing Address - Country:US
Mailing Address - Phone:860-306-9734
Mailing Address - Fax:860-667-0695
Practice Address - Street 1:28 FIELDSTONE PATH
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4631
Practice Address - Country:US
Practice Address - Phone:860-306-9734
Practice Address - Fax:860-667-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty