Healthcare Provider Details

I. General information

NPI: 1306243571
Provider Name (Legal Business Name): EXCEL URGENT CARE OF STAMFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 NEWFIELD AVE
STAMFORD CT
06905-3302
US

IV. Provider business mailing address

484 TEMPLE HILL RD SUITE 104
NEW WINDSOR NY
12553-5529
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-3700
  • Fax: 845-565-3395
Mailing address:
  • Phone: 845-565-3700
  • Fax: 845-565-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTHONY R RUVO
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 845-565-3700