Provider Demographics
NPI:1164732426
Name:NORWALK SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NORWALK SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PROTOMASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-227-5360
Mailing Address - Street 1:40 CROSS ST STE 120
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4698
Mailing Address - Country:US
Mailing Address - Phone:203-546-3377
Mailing Address - Fax:203-546-3381
Practice Address - Street 1:40 CROSS ST STE 120
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4698
Practice Address - Country:US
Practice Address - Phone:203-546-3377
Practice Address - Fax:203-546-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical