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General NPI Number Information
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NPI Number | 1649403320
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL OF DANBURY, LLC
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Dates
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Enumeration Date | 08/28/2009
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 46 MILL PLAIN RD
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City | DANBURY
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State | CT
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Zip | 06811-5140
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Country | US
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Telephone | 203-297-6120
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Fax | 203-297-6122
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Provider Business Mailing Address
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Address Line | 46 MILL PLAIN RD
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City | DANBURY
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State | CT
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Zip | 06811-5140
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Country | US
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Telephone | 203-297-6120
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Fax | 203-297-6122
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. MICHAEL LANCE GERSTENFELD
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Credential | M.D.
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Telephone | 203-297-6120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 031959
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License Number State | CT
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