=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861691362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN CONNECTICUT WOMENS HEALTH CARE ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2007
-----------------------------------------------------
Last Update Date | 09/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 247 BROAD ST
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06460-3267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-783-0543
-----------------------------------------------------
Fax | 203-874-5728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 247 BROAD STREET
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-783-0543
-----------------------------------------------------
Fax | 203-874-5728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | YORAM LIRTZMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-783-0543
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------