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General NPI Number Information
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NPI Number | 1295499820
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Entity Type | Organization
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Legal Business Name | NORTHEAST OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGEONS PLLC
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Dates
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Enumeration Date | 10/29/2021
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 1817 BLACK ROCK TPKE
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City | FAIRFIELD
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State | CT
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Zip | 06825-3515
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Country | US
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Telephone | 203-424-0228
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 BLACK ROCK TPKE
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City | FAIRFIELD
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State | CT
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Zip | 06825-3515
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Country | US
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Telephone | 203-424-0228
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LARISSA HABIB
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Credential | MD
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Telephone | 203-424-0228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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