Provider Demographics
NPI:1457397200
Name:PISERCHIA, STEPHEN C (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:PISERCHIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 CHAPEL STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-776-3375
Mailing Address - Fax:203-776-3171
Practice Address - Street 1:1213 CHAPEL ST
Practice Address - Street 2:NEW HAVEN MEDICAL SPORTS & OCCUPATIONAL HEALTH
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-776-3375
Practice Address - Fax:203-776-3171
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT01097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U56975Medicare UPIN
CTD400008799Medicare PIN