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General NPI Number Information
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NPI Number | 1710936778
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Entity Type | Organization
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Legal Business Name | IRIS WERTHEIM M.D. LLC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 32 STRAWBERRY HILL CT SUITE 41052
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City | STAMFORD
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State | CT
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Zip | 06902-2594
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Country | US
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Telephone | 203-653-5080
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Fax |
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Provider Business Mailing Address
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Address Line | 32 STRAWBERRY HILL CT SUITE 41052
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City | STAMFORD
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State | CT
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Zip | 06902-2594
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Country | US
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Telephone | 203-653-5080
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. IRIS WERTHEIM
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Credential | M.D.
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Telephone | 203-653-5080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 202735-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 039006
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License Number State | CT
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