Basic Information
| Provider Information | |||||||||
| NPI: | 1356331425 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STAMFORD HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HOSPITAL PLZ | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069023602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032761000 | ||||||||
| FaxNumber: | 2032767093 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HOSPITAL PLZ | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069023602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032761000 | ||||||||
| FaxNumber: | 2032767093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 08/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | COLBERG | ||||||||
| AuthorizedOfficialFirstName: | CRIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXEC. DIRECTOR - FINANCIAL PLAN & R | ||||||||
| AuthorizedOfficialTelephone: | 2032767464 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 0059 | CT | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 363LA2200X | 0059 | CT | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 282N00000X | 0059 | CT | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | C00013 | 01 | CT | MEDICARE PART B PROVIDER | OTHER |