Healthcare Provider Details

I. General information

NPI: 1881788198
Provider Name (Legal Business Name): HAYDEE LILIANA BUJMAN DE LANCMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SUMMER ST STE 101
STAMFORD CT
06905
US

IV. Provider business mailing address

1515 SUMMER ST STE 101
STAMFORD CT
06905
US

V. Phone/Fax

Practice location:
  • Phone: 203-323-8171
  • Fax: 203-323-7122
Mailing address:
  • Phone: 203-323-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number037157
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number037157
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: