Organization
GOLD COAST PULMONARY AND SLEEP ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL JUSTIN LICATA D.O. (OWNER/PHYSICIAN)
(860) 443-0305
Entity
Organization
Contact information
Practice address
492 MONTAUK AVE, NEW LONDON, CT 06320-4615
(860) 443-0305
(860) 444-0823
Mailing address
492 MONTAUK AVE, NEW LONDON, CT 06320-4615
(860) 443-0305
(860) 444-0823
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
000413
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50GOLDCOACT01
ANTHEM GROUP NUMBER
CT
Enumeration date
09/29/2006
Last updated
12/03/2007
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