Provider Demographics
NPI:1164143566
Name:THE DIEP GROUP CT PLLC
Entity Type:Organization
Organization Name:THE DIEP GROUP CT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAREEF
Authorized Official - Middle Name:
Authorized Official - Last Name:JANDALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-374-0310
Mailing Address - Street 1:5520 PARK AVE STE WP-2300
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3463
Mailing Address - Country:US
Mailing Address - Phone:203-374-0310
Mailing Address - Fax:
Practice Address - Street 1:5520 PARK AVE STE WP-2300
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3463
Practice Address - Country:US
Practice Address - Phone:203-374-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty