Healthcare Provider Details

I. General information

NPI: 1124120043
Provider Name (Legal Business Name): SAMUEL FRUMKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 KINGS HWY N
WESTPORT CT
06880-2425
US

IV. Provider business mailing address

4 FLORIAN CT
WESTPORT CT
06880-1628
US

V. Phone/Fax

Practice location:
  • Phone: 203-226-0731
  • Fax: 203-226-1792
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number017110
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: