WATERBURY NEUROLOGY LLC NPI 1255378501

NPI Information

NPI: 1255378501
Provider Name: WATERBURY NEUROLOGY LLC
Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Organization

Specialization: Neurology

CLIA Number: 07D2169557

Address:
1625 STRAITS TURNPIKE
SUITE 307
MIDDLEBURY, CT
ZIP 06762
Phone: (203) 758-8995
Get Directions

WATERBURY NEUROLOGY LLC is a neurology psychiatry neurology in Middlebury, CT. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. WATERBURY NEUROLOGY LLC NPI is 1255378501. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1625 STRAITS TURNPIKE
SUITE 307
MIDDLEBURY, CT
ZIP 06762-836
Phone: (203) 758-8995
Fax: (203) 758-2571

The provider's authorized official is Pooia Fattahi .
The authorized official title is Partner and has the following contact phone number (203) 758-8995.

The CLIA number assigned to this NPI record is 07D2169557 - other - bcf with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/2/2006 and was last updated on 4/29/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084N0400X	Psychiatry & Neurology	Neurology		CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	1284603	MEDICAID	CONNECTICUT
2	B38833	MEDICARE UPIN	CONNECTICUT
3	1361138	MEDICAID	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »