Organization
DR. PHILIP A. MONGELLUZZO, JR. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP A. MONGELLUZZO JR. M.D. (OWNER)
(203) 757-3486
Entity
Organization
Contact information
Practice address
2247 EAST MAIN STREET, WATERBURY, CT 06705
(203) 757-3486
(203) 757-4376
Mailing address
93 HEMPEL DRIVE, WOLCOTT, CT 06716
(203) 757-3486
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004245272
—
CT
Enumeration date
10/03/2006
Last updated
06/13/2013
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