Healthcare Provider Details

I. General information

NPI: 1316121726
Provider Name (Legal Business Name): CEASAR IRBY JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MILL HILL AVE 3RD FLOOR
BRIDGEPORT CT
06610-2826
US

IV. Provider business mailing address

PO BOX 415126 MILL HILL MEDICAL CONSULTANTS, INC.
BOSTON MA
02241-0001
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3394
  • Fax: 203-384-3829
Mailing address:
  • Phone: 203-384-3394
  • Fax: 203-384-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number390200000X
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000830
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: