Provider Demographics
NPI:1912973231
Name:TONIONI, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:TONIONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LOEFFLER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2256
Mailing Address - Country:US
Mailing Address - Phone:860-378-2891
Mailing Address - Fax:860-378-2894
Practice Address - Street 1:710 MAIN ST
Practice Address - Street 2:BUILDING 4
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1565
Practice Address - Country:US
Practice Address - Phone:860-378-2891
Practice Address - Fax:860-378-2894
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000931363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V5699OtherHEALTHNET
CT970001333Medicare ID - Type Unspecified
CTP20987Medicare UPIN