Individual
MATTHEW BASILICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 GEORGE ST STE 901, NEW HAVEN, CT 06511-6662
(203) 785-2095
Mailing address
82 FERNWOOD RD, CHESTNUT HILL, MA 02467-2907
(617) 775-6992
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/26/2020
Last updated
11/08/2021
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