Provider Demographics
NPI:1053545616
Name:JOSEPH B. GUARNACCIA, MD, LLC
Entity type:Organization
Organization Name:JOSEPH B. GUARNACCIA, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BLAISE
Authorized Official - Last Name:GUARNACCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-732-1290
Mailing Address - Street 1:130 DIVISION ST
Mailing Address - Street 2:MSTC, C/O GRIFFIN HOSPITAL
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1326
Mailing Address - Country:US
Mailing Address - Phone:203-732-1290
Mailing Address - Fax:302-732-1299
Practice Address - Street 1:130 DIVISION ST
Practice Address - Street 2:MSTC, C/O GRIFFIN HOSPITAL
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1326
Practice Address - Country:US
Practice Address - Phone:203-732-1290
Practice Address - Fax:302-732-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0311792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty