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General NPI Number Information
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NPI Number | 1275562019
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Entity Type | Organization
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Legal Business Name | EAST AVENUE MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 148 EAST AVE 2L
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City | NORWALK
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State | CT
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Zip | 06851-5721
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Country | US
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Telephone | 203-853-2323
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Fax | 203-831-8120
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Provider Business Mailing Address
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Address Line | 148 EAST AVE 2L
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City | NORWALK
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State | CT
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Zip | 06851-5721
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Country | US
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Telephone | 203-853-2323
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Fax | 203-831-8120
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Authorized Official
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Title or Position | OWNER
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Name | DR. HANS MARTIN FUCHS
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Credential | M.D.
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Telephone | 203-853-2323
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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 | 017524
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License Number State | CT
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