Provider Demographics
NPI:1164601795
Name:ASPETUCK HEALTH DISTRICT
Entity Type:Organization
Organization Name:ASPETUCK HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-227-9571
Mailing Address - Street 1:180 BAYBERRY LANE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2802
Mailing Address - Country:US
Mailing Address - Phone:203-227-9571
Mailing Address - Fax:203-221-7199
Practice Address - Street 1:180 BAYBERRY LANE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2802
Practice Address - Country:US
Practice Address - Phone:203-227-9571
Practice Address - Fax:203-221-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034778251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare