Basic Information
| Provider Information | |||||||||
| NPI: | 1194947440 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDDLESEX HOSPITAL DBA MIDDLESEX NEUROLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 S MAIN ST | ||||||||
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| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064573648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603446989 | ||||||||
| FaxNumber: | 8603446748 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064573604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603448224 | ||||||||
| FaxNumber: | 8603441476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | CAPECE | ||||||||
| AuthorizedOfficialFirstName: | VINNIE | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP FINANCA & OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8603446395 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | CT | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.