Healthcare Provider Details

I. General information

NPI: 1134754971
Provider Name (Legal Business Name): JOHN BERMUDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 WESTPORT AVE
NORWALK CT
06851-4344
US

IV. Provider business mailing address

64 RYEGATE TER
MONROE CT
06468-2213
US

V. Phone/Fax

Practice location:
  • Phone: 203-853-4771
  • Fax: 203-853-4771
Mailing address:
  • Phone: 401-921-3320
  • Fax: 401-921-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number000469
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: