NPIMap

Organization Active NPI

Family Practice & Internal Medicine, LLC

  • Internal Medicine Physician
  • North Haven, CT
National Provider Identifier
1902095003
Registry record updated May 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
FAMILY PRACTICE & INTERNAL MEDICINE, LLC
Practice address
52 Washington Ave
Suite 4
North Haven, CT 06473-1724
Phone
(203) 672-2800
Fax
(203) 672-2801
NPI assigned
Oct 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2012

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

Authorized official

Name
Dr. Fausto Petruzziello, MDNPI 1316933419
Title
Owner
Phone
(203) 672-2800

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X Primary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

52 Washington Ave
Suite 4
North Haven, CT 06473-1724

Mailing address

52 Washington Ave
Suite 4
North Haven, CT 06473-1724
Phone (203) 672-2800

Other identifiers 2

IdentifierTypeStateIssuer
500000049MedicaidCT
DG5581OtherCTRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071211000192 CT Part B Supplier - Clinic/Group Practice 5991894123 Receives reassigned benefits from 17 practitioners
Practice locations: Hamden, CT; North Haven, CT; Wallingford, CT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D1070751Family Practice and Internal Medicine, LLC52 Washington Ave, Ste 4, North Haven, CT 06473Certificate of waiverJul 8, 2027

National Provider Directory

National Provider Directory

Locations

2200 Whitney Ave
Ste 101
Hamden, CT 06518

52 Washington Ave
North Haven, CT 06473
Phone (203) 234-7727

50 S Main St
Ste 2B
Wallingford, CT 06492
Phone (203) 294-1200

821 N Main Street Ext
Ste 210
Wallingford, CT 06492
Phone (203) 294-3610

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338422400000",
    "number": "1902095003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 WASHINGTON AVE",
            "address_2": "SUITE 4",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064731724",
            "telephone_number": "203-672-2800",
            "fax_number": "203-672-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 WASHINGTON AVE",
            "address_2": "SUITE 4",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064731724",
            "telephone_number": "203-672-2800",
            "fax_number": "203-672-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE & INTERNAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2012-05-31",
        "status": "A",
        "authorized_official_last_name": "PETRUZZIELLO",
        "authorized_official_first_name": "FAUSTO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-672-2800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500000049",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG5581",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.