Healthcare Provider Details

I. General information

NPI: 1033439039
Provider Name (Legal Business Name): NEIL T SPECHT, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 WHITE PLAINS RD SUITE 206
TRUMBULL CT
06611-4552
US

IV. Provider business mailing address

888 WHITE PLAINS RD SUITE 206
TRUMBULL CT
06611-4552
US

V. Phone/Fax

Practice location:
  • Phone: 203-455-0101
  • Fax: 203-459-8555
Mailing address:
  • Phone: 203-455-0101
  • Fax: 203-459-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27045
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number27045
License Number StateCT

VIII. Authorized Official

Name: NEILL T SPECHT
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 203-445-0101