Healthcare Provider Details

I. General information

NPI: 1255750758
Provider Name (Legal Business Name): HALSAMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2014
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E PUTNAM AVE
GREENWICH CT
06830-5643
US

IV. Provider business mailing address

115 E PUTNAM AVE
GREENWICH CT
06830-5643
US

V. Phone/Fax

Practice location:
  • Phone: 203-517-4600
  • Fax: 888-397-2148
Mailing address:
  • Phone: 203-517-4600
  • Fax: 888-397-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN MURPHY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 203-517-4600