Active NPI
Edward Corsello, D.C
- Internist Chiropractor
- Stratford, CT
National Provider Identifier
1649337452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internist Chiropractor
- License
- CT1562
- Practice address
- 3333 Main St
Stratford, CT 06614-4861 - Phone
- (203) 381-1800
- Fax
- (203) 381-1801
- NPI assigned
- Jan 2, 2007
- 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 |
|---|---|---|---|---|
| Internist Chiropractor | 111NI0900X | CT1562 | CT | Primary |
Addresses
Primary practice location
3333 Main St
Stratford, CT 06614-4861
Mailing address
3333 Main St
Stratford, CT 06614-4861
Phone (203) 381-1800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 050001562CT04 | Other | CT | ANTHEM ID |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CT1562 | CT | MD | Internist Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649337452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3333 MAIN ST",
"city": "STRATFORD",
"state": "CT",
"postal_code": "066144861",
"telephone_number": "203-381-1800",
"fax_number": "203-381-1801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 MAIN ST",
"city": "STRATFORD",
"state": "CT",
"postal_code": "066144861",
"telephone_number": "203-381-1800",
"fax_number": "203-381-1801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORSELLO",
"first_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "D.C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NI0900X",
"taxonomy_group": "",
"desc": "Chiropractor, Internist",
"state": "CT",
"license": "CT1562",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM ID",
"identifier": "050001562CT04",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stratford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.