Provider Demographics
NPI:1033105184
Name:CHOY, OCTAVIO (MD)
Entity Type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:
Last Name:CHOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 QUARRY RD
Mailing Address - Street 2:ATTN: BRENDA SHOLOMICKY
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4874
Mailing Address - Country:US
Mailing Address - Phone:203-696-3668
Mailing Address - Fax:
Practice Address - Street 1:56 QUARRY RD
Practice Address - Street 2:ATTN: BRENDA SHOLOMICKY
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4874
Practice Address - Country:US
Practice Address - Phone:203-696-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001177906Medicaid
B37759Medicare UPIN
CT001177906Medicaid