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General NPI Number Information
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NPI Number | 1578648606
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Entity Type | Individual
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Provider Name | RENIKA N MCLEOD-LABISSIERE MD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 115 WATERBURY ROAD
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City | PROSPECT
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State | CT
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Zip | 06712
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Country | US
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Telephone | 203-758-5660
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Fax | 203-758-3161
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Provider Business Mailing Address
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Address Line | 102 W REDDING RD
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City | DANBURY
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State | CT
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Zip | 06810-8345
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Country | US
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Telephone | 203-743-1810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 230651
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 045025
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License Number State | CT
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