Healthcare Provider Details

I. General information

NPI: 1942492293
Provider Name (Legal Business Name): HIGH RIDGE FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BUXTON FARMS ROAD
STAMFORD CT
06905-1224
US

IV. Provider business mailing address

30 BUXTON FARMS ROAD
STAMFORD CT
06905-1224
US

V. Phone/Fax

Practice location:
  • Phone: 203-322-7070
  • Fax: 203-322-2389
Mailing address:
  • Phone: 203-322-7070
  • Fax: 203-322-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN TODD FALKOFF
Title or Position: CEO
Credential: MD
Phone: 203-322-7070