Healthcare Provider Details

I. General information

NPI: 1518134428
Provider Name (Legal Business Name): CONNECTICUT ALLERGY & ASTHMA ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 MAIN ST
BRIDGEPORT CT
06606
US

IV. Provider business mailing address

4641 MAIN ST
BRIDGEPORT CT
06606
US

V. Phone/Fax

Practice location:
  • Phone: 203-371-6060
  • Fax: 203-371-1977
Mailing address:
  • Phone: 203-371-6060
  • Fax: 203-371-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number020804
License Number State

VIII. Authorized Official

Name: DR. PAUL B GOLDBERG
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 203-371-6060