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General NPI Number Information
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NPI Number | 1629330220
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Entity Type | Organization
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Legal Business Name | CONNECTICUT REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY, PC
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 115 TECHNOLOGY DR SUITE 107B
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City | TRUMBULL
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State | CT
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Zip | 06611-6337
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Country | US
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Telephone | 203-200-7117
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Fax | 203-916-6912
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Provider Business Mailing Address
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Address Line | 3810 CONGRESS ST
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City | FAIRFIELD
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State | CT
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Zip | 06824-2039
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Country | US
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Telephone | 203-292-6049
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Fax | 203-916-6912
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAUN CHRISTOPHER WILLIAMS
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Credential | M.D.
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Telephone | 203-200-7117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 043549
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License Number State | CT
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