Healthcare Provider Details

I. General information

NPI: 1942345830
Provider Name (Legal Business Name): REGIONAL PHYSICIAN SERVICES, CT, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 LEAVENWORTH ST SUITE 200
WATERBURY CT
06702-2115
US

IV. Provider business mailing address

45 MAIN ST SUITE 408
BROOKLYN NY
11201-1000
US

V. Phone/Fax

Practice location:
  • Phone: 866-662-4560
  • Fax: 877-279-9425
Mailing address:
  • Phone: 866-662-4560
  • Fax: 877-279-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS O'CONNOR
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 866-662-4560