| Masonicare Health Center | |
|
22 Masonic Ave Wallingford CT 06492-3048 | |
| (203) 679-5900 | |
| Not Available |
| Full Name | Masonicare Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 22 Masonic Ave, Wallingford, Connecticut |
| Authorized Official Name and Position | Jon-paul Venoit (PRESIDENT & CEO) |
| Authorized Official Contact | 2036795000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Masonicare Health Center 22 Masonic Ave Wallingford CT 06492-3048 Ph: () - | Masonicare Health Center 22 Masonic Ave Wallingford CT 06492-3048 Ph: (203) 679-5900 |
| NPI Number | 1588638688 |
|---|---|
| Provider Enumeration Date | 02/15/2006 |
| Last Update Date | 11/05/2019 |
| Medicare PECOS PAC ID | 4688655541 |
|---|---|
| Medicare Enrollment ID | O20040526001101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588638688 | NPI | - | NPPES |
| 004025425 | Medicaid | CT | |
| 0070177 | Medicaid | CT | |
| 082 | Other | CT | BLUE CROSS |
| 004014791 | Medicaid | CT |
| Provider Name | Robert J Golub |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1851395651 PECOS PAC ID: 6507750593 Enrollment ID: I20040211000154 |
| Provider Name | Holley M Dey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700860699 PECOS PAC ID: 4789675117 Enrollment ID: I20040524000247 |
| Provider Name | Gary J Dee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629052519 PECOS PAC ID: 7416999024 Enrollment ID: I20050524001013 |
| Provider Name | George Spivack |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1720017049 PECOS PAC ID: 9638082381 Enrollment ID: I20051107000061 |
| Provider Name | William J Farrell |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1417951203 PECOS PAC ID: 7012810633 Enrollment ID: I20060309000610 |
| Provider Name | Ronald J Schwartz |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1427034784 PECOS PAC ID: 3779483045 Enrollment ID: I20100113000053 |
| Provider Name | James Carroll |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487639738 PECOS PAC ID: 0446431043 Enrollment ID: I20110301000804 |
| Provider Name | George Charles Laverde |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508029398 PECOS PAC ID: 7810138583 Enrollment ID: I20130723000045 |
| Provider Name | James Choi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1831416437 PECOS PAC ID: 3577877380 Enrollment ID: I20150806010419 |
| Provider Name | John Michael Dinkler |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1710145420 PECOS PAC ID: 3678883386 Enrollment ID: I20151110000457 |
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