Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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NPI 1972942720

Individual provider · NPI 1972942720 Deactivated

This NPI was deactivated on September 24, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1972942720 is listed in the national NPI registry. Works from 2 locations.

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Practice location Incomplete address

The federal record is missing the street or ZIP for this provider.

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Additional practice locations (1)

  • 130 Division St, Derby, CT 06418-3271 — (203) 732-7550

Specialties & licences

Record details

NPI number1972942720
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—