Provider Demographics
NPI:1164196283
Name:CIVIC NORTH HAVEN, LLC
Entity Type:Organization
Organization Name:CIVIC NORTH HAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-883-0038
Mailing Address - Street 1:249 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4010
Mailing Address - Country:US
Mailing Address - Phone:203-883-0038
Mailing Address - Fax:203-724-4838
Practice Address - Street 1:127 WASHINGTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1715
Practice Address - Country:US
Practice Address - Phone:203-883-0038
Practice Address - Fax:203-724-4838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy