Basic Information
| Provider Information | |||||||||
| NPI: | 1508861279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MATTHEW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 69 SAND PIT RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068104004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037482551 | ||||||||
| FaxNumber: | 2037906375 | ||||||||
| Practice Location | |||||||||
| Address1: | 69 SAND PIT RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068104004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037482551 | ||||||||
| FaxNumber: | 2037906375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 204D00000X | CT029734 | CT | Y | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
ID Information
| ID | Type | State | Issuer | Description | 010029734CT01 | 01 | CT | ANTHEM | OTHER | 1297341 | 05 | CT | MEDICAID |