Healthcare Provider Details

I. General information

NPI: 1063828747
Provider Name (Legal Business Name): GREGORY CARFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 HUNT ST
NORWALK CT
06853-1045
US

IV. Provider business mailing address

37 HUNT ST
NORWALK CT
06853
US

V. Phone/Fax

Practice location:
  • Phone: 203-621-4207
  • Fax:
Mailing address:
  • Phone: 203-621-4207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: