Provider Demographics
NPI:1215642673
Name:PAOLILLO, ALPHONSE LOUIS JR (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:ALPHONSE
Middle Name:LOUIS
Last Name:PAOLILLO
Suffix:JR
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5855
Mailing Address - Country:US
Mailing Address - Phone:203-345-0404
Mailing Address - Fax:203-908-4110
Practice Address - Street 1:2595 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5855
Practice Address - Country:US
Practice Address - Phone:203-345-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily