Provider Demographics
NPI:1285839506
Name:THE PHYSICIANS CLEMONS FERRARA PC
Entity type:Organization
Organization Name:THE PHYSICIANS CLEMONS FERRARA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-599-5441
Mailing Address - Street 1:85 CASTLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1978
Mailing Address - Country:US
Mailing Address - Phone:860-599-5441
Mailing Address - Fax:860-599-3479
Practice Address - Street 1:89 CASTLE HILL RD
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1978
Practice Address - Country:US
Practice Address - Phone:860-599-5441
Practice Address - Fax:860-599-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037286208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1285839506OtherGROUP NPI
CTC03742OtherMEDICARE GROUP PTAN