Healthcare Provider Details

I. General information

NPI: 1295030682
Provider Name (Legal Business Name): ALLERGY & ASTHMA CENTER OF STAMFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 04/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 SUMMER ST SUITE A2
STAMFORD CT
06905-5359
US

IV. Provider business mailing address

1275 SUMMER ST SUITE A2
STAMFORD CT
06905-5359
US

V. Phone/Fax

Practice location:
  • Phone: 203-978-0072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number029630
License Number StateCT

VIII. Authorized Official

Name: PAUL LINDNER
Title or Position: DIRECTOR
Credential: MD
Phone: 203-978-0072