Individual
EDWARD G MCKIERNAN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
115 TECHNOLOGY DR, STE A200, TRUMBULL, CT 06611-6338
(203) 268-5801
(203) 452-3688
Mailing address
115 TECHNOLOGY DR, STE A200, TRUMBULL, CT 06611-6338
(203) 268-5801
(203) 452-3688
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004917
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080004917CT04
ANTHEM BCBS PIN
CT
01
—
2V5288
HEALTH NET PIN
CT
01
—
3515548
CIGNA PIN
CT
01
—
3918034
AETNA PIN
CT
01
—
A2983697
OXFORD PIN
CT
Enumeration date
08/31/2006
Last updated
10/14/2010
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