Eastern Connecticut Neurosurgery, P.C.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

030418 Issued in CT

Legal business name

EASTERN CONNECTICUT NEUROSURGERY, P.C.

Practice address

330 Washington St
Suite 540
Norwich, CT 06360-2700

Phone

(860) 859-5137

Fax

(860) 859-5177

NPI assigned

Jan 15, 2009

Organization subpart

No

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

Authorized official

Name

Gregory R. Criscuolo, M.D.NPI 1235170341

Title

Owner/President

Phone

(860) 859-5137

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregory R Criscuolo, M.D.

  • Neurological Surgery Physician
  • Norwich, CT
  • NPI 1235170341

  CT, Neurological Surgery

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1231977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231977600000",
    "number": "1306083142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 MOUNTAINCREST DR",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064103554",
            "telephone_number": "860-859-5137",
            "fax_number": "860-859-5177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 WASHINGTON ST",
            "address_2": "SUITE 540",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602700",
            "telephone_number": "860-859-5137",
            "fax_number": "860-859-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN CONNECTICUT NEUROSURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-15",
        "last_updated": "2009-01-15",
        "status": "A",
        "authorized_official_last_name": "CRISCUOLO",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "860-859-5137",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "CT",
            "license": "030418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001304188",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Norwich, CT
• Neurological Surgery Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.