Provider Information for 1932500055
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NICHOLAS PANTUOSCO
Sex: Male
NPI: 1932500055
Last Updated: 2022-07-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1932500055 | ||||||||
| Enumeration Date | 2014-09-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 995 DAY HILL RD WINDSOR, CT 06095-1722 United States Phone: 860-731-5522 | Fax:860-731-5536 | ||||||||
| Primary Practice Address | 71 WESTCOTT RD DANIELSON, CT 06239-2929 United States Phone: 860-774-7179 | Fax:860-779-6526 | ||||||||
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