Healthcare Provider Details

I. General information

NPI: 1609092121
Provider Name (Legal Business Name): INTERNAL MEDICINE AND INFECTIOUS DISEASE ASSOCIATED P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3241 MAIN STREET SUITE B
STRATFORD CT
06614
US

IV. Provider business mailing address

3241 MAIN STREET SUITE B
STRATFORD CT
06614
US

V. Phone/Fax

Practice location:
  • Phone: 203-383-4466
  • Fax: 203-383-4499
Mailing address:
  • Phone: 203-383-4466
  • Fax: 203-383-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ZANE K SAUL
Title or Position: PRESIDENT
Credential: MD
Phone: 203-383-4466