Healthcare Provider Details

I. General information

NPI: 1023283553
Provider Name (Legal Business Name): DANBURY OFFICE OF PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL AVE
DANBURY CT
06810-6099
US

IV. Provider business mailing address

24 HOSPITAL AVE
DANBURY CT
06810-6099
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-6810
  • Fax: 203-739-6465
Mailing address:
  • Phone: 203-739-6810
  • Fax: 203-739-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: KENNETH F OSWALD
Title or Position: CREDENTIALING REPRESENTATIVE
Credential:
Phone: 203-739-7433