Healthcare Provider Details

I. General information

NPI: 1225941560
Provider Name (Legal Business Name): MATTHEW Q MAGUIRE NREMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 OLD LONG RIDGE RD
STAMFORD CT
06903-1114
US

IV. Provider business mailing address

366 OLD LONG RIDGE RD
STAMFORD CT
06903-1114
US

V. Phone/Fax

Practice location:
  • Phone: 203-461-1141
  • Fax:
Mailing address:
  • Phone: 203-461-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number990458
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: