Healthcare Provider Details

I. General information

NPI: 1376077271
Provider Name (Legal Business Name): NAVDEEP SINGH LAIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 WASHINGTON ST
NORWICH CT
06360-2740
US

IV. Provider business mailing address

462 GRIDER ST
BUFFALO NY
14215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-8331
  • Fax: 860-823-1501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number69322
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number69322
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: