Organization
FAMILY PRACTICE & INTERNAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAUSTO PETRUZZIELLO MD (OWNER)
(203) 672-2800
Entity
Organization
Contact information
Practice address
52 WASHINGTON AVE, SUITE 4, NORTH HAVEN, CT 06473-1724
(203) 672-2800
(203) 672-2801
Mailing address
52 WASHINGTON AVE, SUITE 4, NORTH HAVEN, CT 06473-1724
(203) 672-2800
(203) 672-2801
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500000049
—
CT
01
—
DG5581
RAILROAD MEDICARE
CT
Enumeration date
10/15/2007
Last updated
05/31/2012
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