Healthcare Provider Details

I. General information

NPI: 1700375235
Provider Name (Legal Business Name): ALEXANDER FOGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 03/02/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HAWLEY LN
TRUMBULL CT
06611-5300
US

IV. Provider business mailing address

160 HAWLEY LN
TRUMBULL CT
06611-5300
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-0639
  • Fax: 203-386-9706
Mailing address:
  • Phone: 203-377-0639
  • Fax: 203-386-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number70433
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: