Basic Information
| Provider Information | |||||||||
| NPI: | 1932593837 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DISIENA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 WATERCHASE DR | ||||||||
| Address2: | |||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060672110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602574131 | ||||||||
| FaxNumber: | 8602574519 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 ALVORD PARK RD BLDG B | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067903493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604960455 | ||||||||
| FaxNumber: | 8604962793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2015 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 68067 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.