Basic Information
Provider Information
NPI: 1578721072
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FERRUCCI
FirstName: ALLEN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2408 WHITNEY AVE
Address2:  
City: HAMDEN
State: CT
PostalCode: 065183209
CountryCode: US
TelephoneNumber: 2036260160
FaxNumber: 2032946734
Practice Location
Address1: 2408 WHITNEY AVE
Address2:  
City: HAMDEN
State: CT
PostalCode: 065183209
CountryCode: US
TelephoneNumber: 2034073525
FaxNumber: 2034073526
Other Information
ProviderEnumerationDate: 05/30/2008
LastUpdateDate: 06/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X52984CTN Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207XX0004X52984CTY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery

No ID Information.


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