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General NPI Number Information
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NPI Number | 1760679054
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY ASSCOCIATES OF SOUTHERN CT, LLC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 3715 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-3611
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Country | US
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Telephone | 203-372-4636
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Fax | 203-372-4188
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Provider Business Mailing Address
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Address Line | 3715 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-3618
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Country | US
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Telephone | 203-372-4636
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Fax | 203-372-4188
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL DUBEN
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Credential | MD
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Telephone | 203-372-4636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 041464
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License Number State | CT
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