Healthcare Provider Details

I. General information

NPI: 1104528587
Provider Name (Legal Business Name): CT COMPREHENSIVE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 OXFORD RD UNIT L
OXFORD CT
06478-1900
US

IV. Provider business mailing address

71 OXFORD RD UNIT L
OXFORD CT
06478-1900
US

V. Phone/Fax

Practice location:
  • Phone: 203-828-0013
  • Fax:
Mailing address:
  • Phone: 203-828-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DEIDRE SCHETTINO
Title or Position: MANAGER
Credential:
Phone: 845-464-6289