Healthcare Provider Details

I. General information

NPI: 1518692433
Provider Name (Legal Business Name): WEST RIVER SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2022
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DURHAM RD REAR ENTRANCE
GUILFORD CT
06437-2076
US

IV. Provider business mailing address

5 DURHAM RD STE 1-8
GUILFORD CT
06437-2076
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-7794
  • Fax: 203-458-7580
Mailing address:
  • Phone: 203-453-6635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEREK M. STEINBACHER
Title or Position: DIRECTOR
Credential: MD, DMD, FACS, FRCS
Phone: 617-230-8547