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General NPI Number Information
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NPI Number | 1568733491
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Entity Type | Organization
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Legal Business Name | IP CT, LLC
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 1 BLACHLEY RD
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City | STAMFORD
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State | CT
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Zip | 06902-0002
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Country | US
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Telephone | 203-705-2087
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Fax | 203-705-2927
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Provider Business Mailing Address
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Address Line | PO BOX 626
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City | GREAT RIVER
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State | NY
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Zip | 11739-0626
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Country | US
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Telephone | 203-705-2087
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Fax | 203-705-2927
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. ALICE CHEN
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Credential | MD
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Telephone | 203-705-2087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 070403
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License Number State | CT
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