Individual
ANGELITO C BACAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
281 HARTFORD TPKE, SUITE 210, VERNON, CT 06066-4784
(860) 872-8563
(860) 870-4857
Mailing address
300 BIRCH MOUNTAIN RD, MANCHESTER, CT 06040-6800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
029990
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029990
STATE LICENSE
CT
Enumeration date
07/09/2006
Last updated
07/08/2007
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