Individual
ELIZA FANTARELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
330 ORCHARD ST, NEW HAVEN, CT 06511
(203) 789-3152
(203) 867-5457
Mailing address
330 ORCHARD ST, NEW HAVEN, CT 06511
(203) 789-3152
(203) 867-5457
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
000867
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437319019
—
CT
Enumeration date
06/17/2008
Last updated
06/30/2016
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