Healthcare Provider Details

I. General information

NPI: 1194734855
Provider Name (Legal Business Name): FAMILY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 DANBURY RD
RIDGEFIELD CT
06877-4069
US

IV. Provider business mailing address

96 DANBURY RD
RIDGEFIELD CT
06877-4069
US

V. Phone/Fax

Practice location:
  • Phone: 203-438-0874
  • Fax:
Mailing address:
  • Phone: 203-438-0874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number032270
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number032270
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number032270
License Number StateCT

VIII. Authorized Official

Name: DAVID A PAZER
Title or Position: PRESIDENT
Credential: MD
Phone: 203-438-0874