Basic Information
| Provider Information | |||||||||
| NPI: | 1093291643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAREDRIGHT MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 WAKENOR RD | ||||||||
| Address2: | |||||||||
| City: | WESTPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068803838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466521791 | ||||||||
| FaxNumber: | 8889811828 | ||||||||
| Practice Location | |||||||||
| Address1: | 38 EAST AVE | ||||||||
| Address2: | |||||||||
| City: | NEW CANAAN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068405516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033470472 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2018 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | SHAJAN | ||||||||
| AuthorizedOfficialFirstName: | JOSHAN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2033470472 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.