MEDICARE: FAIRFIELD FAMILY PHYSICIANS,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	039202	CT

General Provider Information

NPI Number	:	1497915359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRFIELD FAMILY PHYSICIANS,LLC

Provider Business Mailing Address
First Line	:	2184 MAIN ST
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06615-5937
Country	:	US
Telephone Number	:	203-378-9002
Fax Number	:	203-375-0336

Provider Business Practice Location Address
First Line	:	2184 MAIN ST
Second Line	:
City	:	STRATFORD
State	:	CT
Zip	:	06615-5937
Country	:	US
Telephone Number	:	203-378-9002
Fax Number	:	203-375-0336

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. LEE JON FOREST
Credential	:	D.O.
Telephone Number	:	203-378-9002

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	01/15/2009

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