Healthcare Provider Details

I. General information

NPI: 1518144211
Provider Name (Legal Business Name): PETER LAFORTE M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MILL RIVER ST
STAMFORD CT
06902-3725
US

IV. Provider business mailing address

70 MILL RIVER ST
STAMFORD CT
06902-3725
US

V. Phone/Fax

Practice location:
  • Phone: 203-348-7573
  • Fax: 203-348-2893
Mailing address:
  • Phone: 203-348-7573
  • Fax: 203-348-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35457
License Number StateCT

VIII. Authorized Official

Name: ROBERT JOSEPH FUCIGNA
Title or Position: PRESIDENT
Credential: M.D
Phone: 203-348-7573