Healthcare Provider Details

I. General information

NPI: 1376931311
Provider Name (Legal Business Name): ST. VINCENT'S MULTISPECIALTY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 BARNUM AVE
STRATFORD CT
06614-5333
US

IV. Provider business mailing address

2660 MAIN ST SUITE 216
BRIDGEPORT CT
06606-5369
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-1777
  • Fax:
Mailing address:
  • Phone: 203-576-5346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOHN GLECKLER
Title or Position: CFO
Credential:
Phone: 203-576-5412