NPIMap

Organization Active NPI

Family Practice & Internal Medicine of Spring Gren LLC

  • Internal Medicine Physician
  • Hamdeh, CT
National Provider Identifier
1255371571
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
FAMILY PRACTICE & INTERNAL MEDICINE OF SPRING GREN LLC
Practice address
2200 Whithey Ave
Suite 100
Hamdeh, CT 06518
Phone
(203) 407-6410
Fax
(203) 407-6433
NPI assigned
Jun 7, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Fausto Peteuzziello, MD
Title
Physician Owner
Phone
(203) 407-6410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2200 Whithey Ave
Suite 100
Hamdeh, CT 06518

Mailing address

2200 Whithey Ave
Suite 100
Hamdeh, CT 06518
Phone (203) 407-6410

National Provider Directory

National Provider Directory

Locations

52 Washington Ave
#4
North Haven, CT 06473
Phone (203) 672-2800

50 S Main St
Wallingford, CT 06492
Phone (203) 269-1485

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255371571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 WHITHEY AVE",
            "address_2": "SUITE 100",
            "city": "HAMDEH",
            "state": "CT",
            "postal_code": "06518",
            "telephone_number": "203-407-6410",
            "fax_number": "203-407-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 WHITHEY AVE",
            "address_2": "SUITE 100",
            "city": "HAMDEH",
            "state": "CT",
            "postal_code": "06518",
            "telephone_number": "203-407-6410",
            "fax_number": "203-407-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE & INTERNAL MEDICINE OF SPRING GREN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETEUZZIELLO",
        "authorized_official_first_name": "FAUSTO",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "203-407-6410",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.