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General NPI Number Information
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NPI Number | 1063787786
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Entity Type | Organization
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Legal Business Name | SKIN CANCER CENTER OF FAIRFIELD COUNTY PC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 148 EAST AVE STE 3B
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City | NORWALK
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State | CT
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Zip | 06851-5726
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Country | US
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Telephone | 917-821-3079
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Fax |
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Provider Business Mailing Address
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Address Line | 148 EAST AVE STE 3B
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City | NORWALK
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State | CT
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Zip | 06851-5726
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Country | US
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Telephone | 917-821-3079
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW HERBST
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Credential | M.D.
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Telephone | 917-821-3079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 044188
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License Number State | CT
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