Provider Demographics
NPI:1205280690
Name:VISCONTI, NIURKA JOHANNIE (DO)
Entity type:Individual
Prefix:DR
First Name:NIURKA
Middle Name:JOHANNIE
Last Name:VISCONTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NIURKA
Other - Middle Name:JOHANNIE
Other - Last Name:MATOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 CORPORATE DR UNIT B104
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6346
Mailing Address - Country:US
Mailing Address - Phone:203-769-9133
Mailing Address - Fax:860-321-4553
Practice Address - Street 1:100 CORPORATE DR UNIT B104
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6346
Practice Address - Country:US
Practice Address - Phone:203-769-9133
Practice Address - Fax:860-321-4553
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63608207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program