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General NPI Number Information
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NPI Number | 1699026724
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Entity Type | Organization
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Legal Business Name | ADVANCED GYNECOLOGY & ROBOTIC SURGEY, LLC
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 4637 MAIN STREET
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5048
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Country | US
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Telephone | 203-374-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 4637 MAIN STREET
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5048
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Country | US
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Telephone | 203-374-8000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHABNAM M KASHANI
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Credential | M.D
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Telephone | 203-374-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 045088
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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