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Organization
GOLD COAST PULMONARY AND SLEEP ASSOCIATES, LLC
Active
Organization
GOLD COAST PULMONARY AND SLEEP ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL JUSTIN LICATA D.O. (OWNER/PHYSICIAN)
(860) 443-0305
Entity
Organization
Contact information
Practice address
492 MONTAUK AVE, NEW LONDON, CT 06320-4615
(860) 443-0305
(860) 444-0823
Mailing address
492 MONTAUK AVE, NEW LONDON, CT 06320-4615
(860) 443-0305
(860) 444-0823
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
000413
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50GOLDCOACT01
ANTHEM GROUP NUMBER
CT
Enumeration date
09/29/2006
Last updated
12/03/2007
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