Healthcare Provider Details

I. General information

NPI: 1205254075
Provider Name (Legal Business Name): DANIEL BENJAMIN LAX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 POST RD E STE 201
WESTPORT CT
06880-5200
US

IV. Provider business mailing address

728 POST RD E STE 201
WESTPORT CT
06880-5200
US

V. Phone/Fax

Practice location:
  • Phone: 203-203-8284
  • Fax: 203-732-8136
Mailing address:
  • Phone: 203-203-8284
  • Fax: 203-732-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number64021
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number293023-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: