Basic Information
| Provider Information | |||||||||
| NPI: | 1730313461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASIERO | ||||||||
| FirstName: | DEENA | ||||||||
| MiddleName: | COSTANZA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PETROCELLI | ||||||||
| OtherFirstName: | DEENA | ||||||||
| OtherMiddleName: | COSTANZA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060308082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606797692 | ||||||||
| FaxNumber: | 8606796649 | ||||||||
| Practice Location | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060308082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606797692 | ||||||||
| FaxNumber: | 8606796649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2009 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 048246 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0010X | 048246 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
No ID Information.