NPIMap

Organization Active NPI

Domenic W. Casablanca, M.D., P.C.

  • Primary Care Clinic/Center
  • Shelton, CT
National Provider Identifier
1730399411
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
DOMENIC W. CASABLANCA, M.D., P.C.
Practice address
4 Corporate Dr
Suite 195
Shelton, CT 06484-6211
Phone
(203) 225-0375
Fax
(203) 225-0376
NPI assigned
May 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Domenic William Casablanca, M.D.NPI 1548227267
Title
President
Phone
(203) 225-0375

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

4 Corporate Dr
Suite 195
Shelton, CT 06484-6211

Mailing address

4 Corporate Dr
Suite 195
Shelton, CT 06484-6211
Phone (203) 225-0375

Other identifiers 1

IdentifierTypeStateIssuer
DC4029OtherCTMEDICARE RAILROAD

National Provider Directory

National Provider Directory

Locations

4 Corporate Dr
Ste 195
Shelton, CT 06484
Phone (203) 225-0375

Practitioners & affiliated clinicians

Practitioners 5

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": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730399411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 CORPORATE DR",
            "address_2": "SUITE 195",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064846211",
            "telephone_number": "203-225-0375",
            "fax_number": "203-225-0376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 CORPORATE DR",
            "address_2": "SUITE 195",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064846211",
            "telephone_number": "203-225-0375",
            "fax_number": "203-225-0376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMENIC W. CASABLANCA, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CASABLANCA",
        "authorized_official_first_name": "DOMENIC",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-225-0375",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DC4029",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.