NPIMap

Organization Active NPI

Dr. Philip a. Mongelluzzo, Jr. LLC

  • Internal Medicine Physician
  • Waterbury, CT
National Provider Identifier
1275627093
Registry record updated Jun 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DR. PHILIP A. MONGELLUZZO, JR. LLC
Practice address
2247 East Main Street
Waterbury, CT 06705
Phone
(203) 757-3486
Fax
(203) 757-4376
NPI assigned
Oct 3, 2006
Last updated
Jun 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2013

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

Authorized official

Name
Dr. Philip A. Mongelluzzo Jr., M.D.NPI 1871563247
Title
Owner
Phone
(203) 757-3486

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

2247 East Main Street
Waterbury, CT 06705

Mailing address

93 Hempel Drive
Wolcott, CT 06716
Phone (203) 757-3486

Other identifiers 1

IdentifierTypeStateIssuer
004245272MedicaidCT

National Provider Directory

National Provider Directory

Locations

3 Flanders Rd
Bethlehem, CT 06751
Phone (203) 266-5202

2247 E Main St
Waterbury, CT 06705
Phone (203) 573-0280

2247 E Main St
Ste 103
Waterbury, CT 06705
Phone (203) 527-7269

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371081600000",
    "number": "1275627093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "93 HEMPEL DRIVE",
            "city": "WOLCOTT",
            "state": "CT",
            "postal_code": "06716",
            "telephone_number": "203-757-3486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2247 EAST MAIN STREET",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06705",
            "telephone_number": "203-757-3486",
            "fax_number": "203-757-4376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. PHILIP A. MONGELLUZZO, JR. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2013-06-13",
        "status": "A",
        "authorized_official_last_name": "MONGELLUZZO",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-757-3486",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004245272",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; 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.