Provider Demographics
NPI:1043414352
Name:JOSEPH AFERZON, MD, LLC
Entity Type:Organization
Organization Name:JOSEPH AFERZON, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AFERZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-832-4664
Mailing Address - Street 1:114 WEST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051
Mailing Address - Country:US
Mailing Address - Phone:860-832-4664
Mailing Address - Fax:860-832-4665
Practice Address - Street 1:114 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051
Practice Address - Country:US
Practice Address - Phone:860-832-4664
Practice Address - Fax:860-832-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207T00000X
035092207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT105029500Medicaid
CT001350925Medicaid
CT105029500Medicaid
G29464Medicare UPIN
CTG29464Medicare UPIN