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General NPI Number Information
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NPI Number | 1316311988
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Entity Type | Organization
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Legal Business Name | FAIRFIELD ALTERNATIVE HEALTH AND MEDICINE, LLC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 630 BROOKLAWN AVE
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City | BRIDGEPORT
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State | CT
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Zip | 06604-1528
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Country | US
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Telephone | 616-796-5209
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Fax | 203-612-8634
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Provider Business Mailing Address
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Address Line | 1019 MAIN ST SUITE 197
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City | BRIDGEPORT
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State | CT
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Zip | 06604-4221
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Country | US
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Telephone | 616-796-5209
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Fax | 203-612-8634
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Authorized Official
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Title or Position | NATUROPATH PHYSICIAN
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Name | JAHON LEE
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Credential | ND
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Telephone | 616-796-5209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 000543
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License Number State | CT
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