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General NPI Number Information
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NPI Number | 1265593990
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Entity Type | Organization
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Legal Business Name | NEW CANAAN INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 173 EAST AVENUE
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City | NEW CANAAN
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State | CT
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Zip | 06840
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Country | US
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Telephone | 203-972-4255
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Fax | 203-972-6345
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Provider Business Mailing Address
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Address Line | 173 EAST AVENUE
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City | NEW CANAAN
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State | CT
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Zip | 06840
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Country | US
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Telephone | 203-972-4255
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Fax | 203-972-6345
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Authorized Official
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Title or Position | MEMBER
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Name | PETER G HASAPIS
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Credential | MD
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Telephone | 203-972-4255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 03877
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License Number State | CT
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