Healthcare Provider Details

I. General information

NPI: 1124235015
Provider Name (Legal Business Name): DAVID NILSON ASSIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST 1080 LMP
NEW HAVEN CT
06520
US

IV. Provider business mailing address

333 CEDAR STREET 1080 LMP
NEW HAVEN CT
06520
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-0712
  • Fax:
Mailing address:
  • Phone: 203-785-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number051778
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number051778
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: