Healthcare Provider Details

I. General information

NPI: 1598708091
Provider Name (Legal Business Name): GARY I SCHECTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST SUITE 101A
THOMASTON CT
06787-1747
US

IV. Provider business mailing address

46 ROCKLEDGE LOOP
TORRINGTON CT
06790-3059
US

V. Phone/Fax

Practice location:
  • Phone: 860-283-5223
  • Fax: 860-283-5124
Mailing address:
  • Phone: 860-283-5223
  • Fax: 860-283-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number031896
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: