EASTERN CONNECTICUT NEUROSURGERY, P.C. (NPI# 1306083142) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306083142 |
| Entity Type | Organization |
| Organization Name | EASTERN CONNECTICUT NEUROSURGERY, P.C. |
| Practice Address |
330 Washington St Suite 540 Norwich CT 06360-2700 |
| Mailing Address |
7 Mountaincrest Dr Cheshire CT 06410-3554 |
| Practice Telephone | 8608595137 |
| Practice Fax Number | 8608595177 |
| Mailing Telephone | 8608595137 |
| Mailing Fax Number | 8608595177 |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2009-01-15 |
| Authorized Official Name | GREGORY R. CRISCUOLO (OWNER/PRESIDENT) |
| Authorized Official Telephone | 8608595137 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | 030418 | CT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 001304188 | 05 |
| Street Address |
330 WASHINGTON ST SUITE 540 |
| City | NORWICH |
| State | CT |
| Zip Code | 06360-2700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447247788 | Olimpia A Radu | Internal Medicine | 330 Washington St, Ste 430, Norwich, CT 06360-2700 | 2005-10-03 |
| 1912458704 | Allan Dierman | Nurse Practitioner | 330 Washington St, Suite 510, Norwich, CT 06360-2700 | 2016-10-17 |
| 1528467016 | Lisa Decarlo | Nurse Practitioner | 330 Washington St, Suite 510, Norwich, CT 06360-2700 | 2014-08-20 |
| 1952700197 | Maura Theresa Forte | Nurse Practitioner | 330 Washington St, Suite 510, Norwich, CT 06360-2700 | 2014-08-13 |
| 1497012520 | Erin Marie Loughery | Nurse Practitioner | 330 Washington St, Suite 350, Norwich, CT 06360-2700 | 2012-04-13 |
| 1003047481 | Melody Mukon | Physician Assistant | 330 Washington St, Suite 220, Norwich, CT 06360-2700 | 2009-08-03 |
| 1801032784 | Ct Podiatry & Foot Surgery, LLC | Podiatrist | 330 Washington St, Suite 310, Norwich, CT 06360-2700 | 2008-12-26 |
| 1700042900 | Joanne Cantor Friedman | Nurse Practitioner | 330 Washington St, Suite 350, Norwich, CT 06360-2700 | 2008-08-06 |
| 1447415815 | Generations Family Health Center, Inc. | Clinic/Center | 330 Washington St, Ste 510, Norwich, CT 06360-2700 | 2008-07-24 |
| 1265693931 | Priya Bakaya | Internal Medicine | 330 Washington St, Ste 430, Norwich, CT 06360-2700 | 2008-06-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003417452 | Mafe Duyan Rato | Nurse Practitioner | 624 W West Main St, St 140, Norwich, CT 06360 | 2020-11-03 |
| 1255961561 | Holly M. Renstrom | Driver | 17 Annadell Rd, Norwich, CT 06360 | 2020-01-26 |
| 1609335397 | Chanel Justice | Social Worker | 2 Clinic Drive, Outpatient Clinic for Children, Norwich, CT 06360 | 2019-03-13 |
| 1457700189 | Michelle Pressler | Pharmacist | 634 West Main St, Norwich, CT 06360 | 2016-06-03 |
| 1265895726 | Katie Johnson | Social Worker | 18 Oneco Street, Norwich, CT 06360 | 2016-04-01 |
| 1871956623 | Lori Deslandes-paz | Pharmacist | 372 West Main Street, Norwich, CT 06360 | 2016-03-30 |
| 1336526193 | Keep An Open Mind, LLC | Marriage & Family Therapist | 12 Cass Street, Suite 202, Norwich, DC 06360 | 2015-04-30 |
| 1588084446 | Kinneri Kothari | Ophthalmology | 79 Wawecus St Ste 105, Norwich, CT 06360 | 2014-04-18 |
| 1962746537 | Robin B Smith | Social Worker | 401 W. Thames St, Bldg 301, Southeastern Mental Health Authority, Norwich, CT 06360 | 2012-11-20 |
| 1063766400 | Colleen Ellen Phillips-white | Social Worker | 401 West Thames St, Bldg 301, Southeastern Mental Health Authority, Norwich, CT 06360 | 2012-11-07 |
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| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114062064 | C. G. Salame M.d. L.L.C. | Neurological Surgery | One Towne Park Plz, Norwich, CT 06360-2247 | 2007-02-20 |
| 1184782070 | Camille G. Salame | Neurological Surgery | 1 Towne Park Plz, Norwich, CT 06360-2247 | 2006-12-05 |
| 1235170341 | Gregory R Criscuolo | Neurological Surgery | 330 Washington St, Suite 540, Norwich, CT 06360-2700 | 2006-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578801437 | David Silverstein | Neurological Surgery | 44 Dillon Rd, Woodbridge, CT 06525-1219 | 2013-01-27 |
| 1558627232 | Ali Reza Nourizadeh | Neurological Surgery | 50 Birch Hill Dr, New Britain, CT 06052-1804 | 2012-04-06 |
| 1295005643 | John A Calogero | Neurological Surgery | 148 Lawler Rd, West Hartford, CT 06117-2621 | 2012-01-03 |
| 1215255278 | Matthew John During | Neurological Surgery | 8 Nearwater Rd, Norwalk, CT 06853-1711 | 2010-05-13 |
| 1609010719 | Joshua Marcus | Neurological Surgery | 67 Sand Pit Rd Ste 208, Danbury, CT 06810-4032 | 2009-04-21 |
| 1396906418 | Ervin Eugene Hanson | Neurological Surgery | 7 Deer Park Ct, Greenwich, CT 06830-3803 | 2008-06-20 |
| 1851566228 | Arianne Jeaneve Boylan | Neurological Surgery | Yale Department of Neurosurgery, 333 Cedar Street, New Haven, CT 06520 | 2008-04-28 |
| 1235307125 | Orthopaedic Specialty Group | Neurological Surgery | 2 Enterprise Dr, Shelton, CT 06484-4600 | 2008-02-14 |
| 1245408137 | Orthopaedic Specialty Group | Neurological Surgery | 2909 Main Street, Stratford, CT 06614 | 2008-02-14 |
| 1477737328 | Patrick P Mastroianni Md PC | Neurological Surgery | 340 Capital Ave, Bridgeport, CT 06606 | 2007-12-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.