Basic Information
| Provider Information | |||||||||
| NPI: | 1407808645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AFFANY | ||||||||
| FirstName: | ABDELMONIM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 WATERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060012097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606742691 | ||||||||
| FaxNumber: | 8606776443 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 WATERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060012097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606742691 | ||||||||
| FaxNumber: | 8606776443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 043447 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.