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General NPI Number Information
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NPI Number | 1073847851
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Entity Type | Organization
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Legal Business Name | NORWALK GYNECOLOGY CENTER LLC
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 107 GLENBROOK RD
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City | STAMFORD
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State | CT
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Zip | 06902-3001
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Country | US
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Telephone | 203-588-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 1544 BEDFORD ST APT 4
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City | STAMFORD
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State | CT
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Zip | 06905-4729
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Country | US
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Telephone | 413-626-5164
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RITA S CASTILLO
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Credential | M.D.
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Telephone | 413-626-5164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 045992
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License Number State | CT
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