Organization
DOMENIC W. CASABLANCA, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMENIC WILLIAM CASABLANCA M.D. (PRESIDENT)
(203) 225-0375
Entity
Organization
Contact information
Practice address
4 CORPORATE DR, SUITE 195, SHELTON, CT 06484-6211
(203) 225-0375
(203) 225-0376
Mailing address
4 CORPORATE DR, SUITE 195, SHELTON, CT 06484-6211
(203) 225-0375
(203) 225-0376
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC4029
MEDICARE RAILROAD
CT
Enumeration date
05/23/2007
Last updated
08/22/2020
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