Organization
NANNI MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDERIC GERARD NANNI (PRESIDENT/OWNER)
(203) 910-1924
Entity
Organization
Contact information
Practice address
477 HIGHLAND AVE, WATERBURY, CT 06708-3432
(203) 755-7242
(203) 755-0021
Mailing address
477 HIGHLAND AVE, WATERBURY, CT 06708-3432
(203) 755-7242
(203) 755-0021
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
5118230001
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A08009815
SUBMITTER NUMBER
CT
Enumeration date
10/11/2006
Last updated
08/22/2020
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