Healthcare Provider Details

I. General information

NPI: 1437700531
Provider Name (Legal Business Name): FAIRFIELD INTERVENTIONAL AND VASCULAR SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SASCO HILL RD STE 2
FAIRFIELD CT
06824-5670
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 300
DOWNERS GROVE IL
60515-1069
US

V. Phone/Fax

Practice location:
  • Phone: 203-256-0070
  • Fax: 203-256-0077
Mailing address:
  • Phone: 630-725-2700
  • Fax: 833-842-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LORENZ ESPARZA
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 630-725-2764