Healthcare Provider Details

I. General information

NPI: 1932210630
Provider Name (Legal Business Name): WESTSPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 KINGS HWY NORTH
WESTPORT CT
06880
US

IV. Provider business mailing address

129 KINGS HWY NORTH
WESTPORT CT
06880
US

V. Phone/Fax

Practice location:
  • Phone: 203-226-8660
  • Fax: 203-226-8670
Mailing address:
  • Phone: 203-226-8660
  • Fax: 203-226-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberCT034778
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberCT034778
License Number StateCT

VIII. Authorized Official

Name: DR. STUART LEONARD STEINMAN
Title or Position: PHYSICIAN/PRESIDENT
Credential: MD
Phone: 203-226-8660