Healthcare Provider Details

I. General information

NPI: 1053509067
Provider Name (Legal Business Name): STACEY M LANGSAM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 LITCHFIELD ST
TORRINGTON CT
06790-6669
US

IV. Provider business mailing address

538 LITCHFIELD ST
TORRINGTON CT
06790-6669
US

V. Phone/Fax

Practice location:
  • Phone: 860-489-5068
  • Fax: 860-489-3725
Mailing address:
  • Phone: 860-489-5068
  • Fax: 860-489-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2447351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: