Active NPI
Frank Fanella Jr., MEDICAL DOCTOR
- Pediatrics Physician
- New Milford, CT
National Provider Identifier
1366449324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 035965
- Practice address
- 120 Park LN
Suite a-101
New Milford, CT 06776-2428 - Phone
- (860) 355-8190
- Fax
- (860) 355-3856
- NPI assigned
- Jul 6, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 035965 | CT | Primary |
Addresses
Primary practice location
120 Park LN
Suite a-101
New Milford, CT 06776-2428
Mailing address
11 Mockingbird LN
New Milford, CT 06776-3252
Phone (860) 355-2625
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035965 | CT | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Candlewood Valley Pediatrics, P.C. | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- ffanellamd@ctproviderdirect.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483488000000",
"number": "1366449324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 MOCKINGBIRD LN",
"city": "NEW MILFORD",
"state": "CT",
"postal_code": "067763252",
"telephone_number": "860-355-2625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 PARK LN",
"address_2": "SUITE A-101",
"city": "NEW MILFORD",
"state": "CT",
"postal_code": "067762428",
"telephone_number": "860-355-8190",
"fax_number": "860-355-3856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANELLA",
"first_name": "FRANK",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MEDICAL DOCTOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-06",
"last_updated": "2017-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CT",
"license": "035965",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Milford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.