Healthcare Provider Details

I. General information

NPI: 1992372403
Provider Name (Legal Business Name): FLYTE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 GROVE ST
NEW CANAAN CT
06840-5325
US

IV. Provider business mailing address

69 GROVE ST
NEW CANAAN CT
06840-5325
US

V. Phone/Fax

Practice location:
  • Phone: 646-397-0208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BASS
Title or Position: COO
Credential:
Phone: 415-710-7775