Healthcare Provider Details

I. General information

NPI: 1760563746
Provider Name (Legal Business Name): MEDICAL SPECIALISTS OF FAIRFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 POST RD SOUTH LOBBY
FAIRFIELD CT
06824-6232
US

IV. Provider business mailing address

425 POST RD SOUTH LOBBY
FAIRFIELD CT
06824-6232
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-4545
  • Fax: 203-254-1191
Mailing address:
  • Phone: 203-255-4545
  • Fax: 203-254-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: GLEN REZNIKOFF
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 203-255-4545