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George Daniel Disesa

Internal Medicine

Allopathic & Osteopathic Physicians

PECOS Enrollment

This provider is enrolled in PECOS as GEORGE DISESA.

Based on the most recent information from CMS, provider George Daniel Disesa is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:14 PM.

Profile Details

Provider ID
1255835393
Provider Type
Individual
Full Name
Disesa, George Daniel
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
3/22/2018
Last Updated
6/13/2025

Contact Information

Practice Location

20 York St, New Haven, CT 06510-3220

(203) 688-4242

Unlisted Fax

Mailing Location

20 York St, New Haven, CT 06510-3220

(203) 688-4242

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 79055 Connecticut
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License 12821441-1205 Utah

George Daniel Disesa

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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