Provider Information for 1669831186
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JASON A CARRESE D.O.
Sex: Male
NPI: 1669831186
Last Updated: 2019-05-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1669831186 | ||||||||||||
| Enumeration Date | 2016-02-11 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-8082 United States Phone: 860-679-4477 | Fax:860-679-1025 | ||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-8082 United States Phone: 860-679-4477 | Fax:860-679-1025 | ||||||||||||
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