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General NPI Number Information
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NPI Number | 1528481090
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Entity Type | Organization
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Legal Business Name | FAIRFIELD COUNTY HEALTH & WELLNESS SERVICES, LLC
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 325 REEF RD SUITE # 109
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City | FAIRFIELD
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State | CT
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Zip | 06824-6537
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Country | US
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Telephone | 203-955-1822
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Fax | 203-955-1823
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Provider Business Mailing Address
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Address Line | 325 REEF RD SUITE # 109
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City | FAIRFIELD
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State | CT
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Zip | 06824-6537
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Country | US
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Telephone | 203-955-1822
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Fax | 203-955-1823
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Authorized Official
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Title or Position | PARTNER
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Name | DR. TASNEEM AHMAD KHAN
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Credential | M.D.
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Telephone | 203-980-9969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 034005
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License Number State | CT
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