Healthcare Provider Details

I. General information

NPI: 1780589762
Provider Name (Legal Business Name): NOAH KLEINHENZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 N BENSON RD
FAIRFIELD CT
06824-5195
US

IV. Provider business mailing address

575 ELLSWORTH ST APT 204
BRIDGEPORT CT
06605-2516
US

V. Phone/Fax

Practice location:
  • Phone: 203-254-4150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: