Healthcare Provider Details

I. General information

NPI: 1164196283
Provider Name (Legal Business Name): CIVIC NORTH HAVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 WASHINGTON AVE STE 4
NORTH HAVEN CT
06473-1715
US

IV. Provider business mailing address

249 DANBURY RD
WILTON CT
06897-4010
US

V. Phone/Fax

Practice location:
  • Phone: 203-883-0038
  • Fax: 203-724-4838
Mailing address:
  • Phone: 203-883-0038
  • Fax: 203-724-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARRY D STEIN
Title or Position: PARTNER
Credential: MD
Phone: 203-883-0038