Basic Information
| Provider Information | |||||||||
| NPI: | 1962997940 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOCTORS OFFICE CT PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEW CANAAN URGENT CARE PLLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 WAKENOR RD | ||||||||
| Address2: | |||||||||
| City: | WESTPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068803838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466521791 | ||||||||
| FaxNumber: | 8889811828 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 RIVER RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | COS COB | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068072152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033470472 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2018 | ||||||||
| LastUpdateDate: | 05/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | SHAJAN | ||||||||
| AuthorizedOfficialFirstName: | JOSHAN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2036352446 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.