Provider Demographics
NPI:1740267319
Name:MAGNANO, BRIAN J
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:MAGNANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4068
Mailing Address - Country:US
Mailing Address - Phone:866-582-0389
Mailing Address - Fax:860-582-3607
Practice Address - Street 1:641 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4068
Practice Address - Country:US
Practice Address - Phone:866-582-0389
Practice Address - Fax:860-582-3607
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
111199OtherHEALTHPARTNERS
CT08007294CT16OtherBLUE CROSS
2V5785OtherHEALTHNET
P354241OtherOXFORD
CT3697028OtherAETNA