Basic Information
| Provider Information | |||||||||
| NPI: | 1962874859 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH STAMFORD MEDICAL ASSOCIATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 E PUTNAM AVE | ||||||||
| Address2: | COURTYARD | ||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068305429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033409611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 816 HIGH RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069051903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033409611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2015 | ||||||||
| LastUpdateDate: | 10/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2033409611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0201X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
No ID Information.