Provider Demographics
NPI:1316960594
Name:AFERZON, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:AFERZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YOFIF
Other - Middle Name:
Other - Last Name:AFERZON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:595 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1156
Mailing Address - Country:US
Mailing Address - Phone:860-832-4664
Mailing Address - Fax:860-832-4665
Practice Address - Street 1:595 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1156
Practice Address - Country:US
Practice Address - Phone:860-832-4664
Practice Address - Fax:860-832-4665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035092208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001350925Medicaid
CTG29464Medicare UPIN
CT1440000152Medicare PIN
1440000152Medicare PIN
G29464Medicare UPIN