Individual
JENINE DECAPRIO GESINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
Mailing address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
000723
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134132244
—
CT
01
—
D400039491
MEDICARE
CT
Enumeration date
08/14/2006
Last updated
01/24/2012
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