Healthcare Provider Details

I. General information

NPI: 1588609473
Provider Name (Legal Business Name): MORGAN STREET FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MORGAN ST SUITE 203
STAMFORD CT
06905-5466
US

IV. Provider business mailing address

90 MORGAN ST SUITE 203
STAMFORD CT
06905-5466
US

V. Phone/Fax

Practice location:
  • Phone: 203-359-9997
  • Fax: 203-359-9957
Mailing address:
  • Phone: 203-359-9997
  • Fax: 203-359-9957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HENRY YOON
Title or Position: MEMBER
Credential: M.D.
Phone: 203-359-9997