Provider Demographics
NPI:1831781376
Name:GAETANO, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:GAETANO
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 1:503 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2917
Mailing Address - Country:US
Mailing Address - Phone:646-596-1246
Mailing Address - Fax:
Practice Address - Street 1:503 CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-2917
Practice Address - Country:US
Practice Address - Phone:646-596-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider