Basic Information
| Provider Information | |||||||||
| NPI: | 1255750758 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HALSAMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 E PUTNAM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068305643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035174600 | ||||||||
| FaxNumber: | 8883972148 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 E PUTNAM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068305643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035174600 | ||||||||
| FaxNumber: | 8883972148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2014 | ||||||||
| LastUpdateDate: | 04/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2035174600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207QB0002X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine |
No ID Information.