Healthcare Provider Details

I. General information

NPI: 1235124272
Provider Name (Legal Business Name): STEPHEN J KAYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 BROADWAY ST
COLCHESTER CT
06415-1022
US

IV. Provider business mailing address

112 LAFAYETTE ST
NORWICH CT
06360-2737
US

V. Phone/Fax

Practice location:
  • Phone: 860-537-4601
  • Fax: 860-537-6935
Mailing address:
  • Phone: 860-537-4601
  • Fax: 860-537-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number017860
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number017860
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: