Healthcare Provider Details

I. General information

NPI: 1427246347
Provider Name (Legal Business Name): CT FERTILITY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TECHNOLOGY DRIVE SUITE 210
TRUMBULL CT
06611-6303
US

IV. Provider business mailing address

100 TECHNOLOGY DRIVE SUITE 210
TRUMBULL CT
06611-6303
US

V. Phone/Fax

Practice location:
  • Phone: 203-373-1200
  • Fax: 203-416-5445
Mailing address:
  • Phone: 203-373-1200
  • Fax: 203-416-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN GAGNE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 203-373-1200