Basic Information
| Provider Information | |||||||||
| NPI: | 1922481571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOSSI NOOAM | ||||||||
| FirstName: | VICTOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 YORK STREET, CB-329 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033844677 | ||||||||
| FaxNumber: | 2033843135 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 SEASIDE AVE | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064604603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033011070 | ||||||||
| FaxNumber: | 2033011542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2015 | ||||||||
| LastUpdateDate: | 06/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 62953 | CT | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.