Individual provider Active NPI

David Lisi Celini, PA

  • Physician Assistant
  • Stratford, CT
National Provider Identifier
1932790557
Registry record updated Jan 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5122 Issued in CT
Practice address
60 Watson Blvd
Stratford, CT 06615-7171
Phone
(203) 380-5945
NPI assigned
Jan 27, 2021
Last updated
Jan 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5122 CT Primary

Addresses

Primary practice location

60 Watson Blvd
Stratford, CT 06615-7171

Mailing address

63 Belleview Dr
Derby, CT 06418-2304

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210202002139 CT Practitioner - Physician Assistant 8628482668 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5122CTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care P.a. CurrentSince Feb 8, 2021 Accepting new patients
American Current Care PA CurrentSince Feb 8, 2021 Accepting new patients

Locations

701 Main St
East Hartford, CT 06108
Phone (860) 289-5561

60 Watson Blvd
Stratford, CT 06615
Phone (203) 380-5945

5080 Spectrum Dr
Ste 1200W
Addison, TX 75001

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1932790557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 BELLEVIEW DR",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064182304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 WATSON BLVD",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066157171",
            "telephone_number": "203-380-5945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CELINI",
        "first_name": "DAVID",
        "middle_name": "LISI",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-27",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "5122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stratford, CT

Sources for this page

Verify at the official NPI Registry.