Healthcare Provider Details

I. General information

NPI: 1518432574
Provider Name (Legal Business Name): IMPACT HEALTH ME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 PORTLAND ST
YARMOUTH ME
04096-8101
US

IV. Provider business mailing address

14 WESTPORT AVE
NORWALK CT
06851-3915
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-4805
  • Fax: 516-887-8494
Mailing address:
  • Phone: 516-705-4805
  • Fax: 516-887-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ISAAC STEG
Title or Position: OWNER
Credential:
Phone: 516-887-8494