Provider Demographics
NPI:1235500083
Name:FAIRFIELD ALTERNATIVE HEALTH AND MEDICINE
Entity Type:Organization
Organization Name:FAIRFIELD ALTERNATIVE HEALTH AND MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAHON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:203-689-2450
Mailing Address - Street 1:1019 MAIN ST SUITE 197
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604
Mailing Address - Country:US
Mailing Address - Phone:203-689-2450
Mailing Address - Fax:
Practice Address - Street 1:630 BROOKLAWN AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1528
Practice Address - Country:US
Practice Address - Phone:203-612-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000543175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty