Healthcare Provider Details

I. General information

NPI: 1992969364
Provider Name (Legal Business Name): STONY CREEK URGENT CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BUSINESS PARK DR SUITE 302
BRANFORD CT
06405-2988
US

IV. Provider business mailing address

6 BUSINESS PARK DR SUITE 302
BRANFORD CT
06405-2988
US

V. Phone/Fax

Practice location:
  • Phone: 203-483-4580
  • Fax: 203-483-4581
Mailing address:
  • Phone: 203-483-4580
  • Fax: 203-483-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID J YOUNG
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 203-483-4580