John Antonucci
Individual provider Active NPI Addiction Medicine (Psychiatry & Neurology) Physician · Newington, CT
NPI 1508967951 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508967951
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X
- License
- 09502 (CT)
- Practice address
- 555 Willard Ave
Newington, CT 06111-2631 - Phone
- (860) 677-6747
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09502 | CT | MD | Addiction Medicine (Psychiatry & Neurology) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | 09502 | CT | Yes |
Addresses
Primary practice location
555 Willard Ave
Newington, CT 06111-2631
Mailing address
11 Woodchuck Hill Rd
Canton, CT 06019-2132
Other providers in Newington, CT
- Ams Solutions
- Krista Anagnostou
- Samantha Anderson
- Sarah Anderson
- Karli Andrews
- Alma N Anunciado
- Joseph Mark Apanowitch
- Ramon Apellaniz
- Bertha Ileana Argueta
- Gabriel Oluseun Arimoro
All providers in Newington, CT · Addiction Medicine (Psychiatry & Neurology) Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.