Provider Demographics
NPI:1194840827
Name:CITY OF BRIDGEPORT DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:CITY OF BRIDGEPORT DEPARTMENT OF HEALTH
Other - Org Name:CENTRAL SCHOOL BASED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-576-7680
Mailing Address - Street 1:752 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06608-2335
Mailing Address - Country:US
Mailing Address - Phone:203-576-7052
Mailing Address - Fax:203-332-5641
Practice Address - Street 1:1 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5502
Practice Address - Country:US
Practice Address - Phone:203-332-5546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service