Provider Demographics
NPI:1275562019
Name:EAST AVENUE MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:EAST AVENUE MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-853-2323
Mailing Address - Street 1:148 EAST AVE
Mailing Address - Street 2:2L
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5721
Mailing Address - Country:US
Mailing Address - Phone:203-853-2323
Mailing Address - Fax:203-831-8120
Practice Address - Street 1:148 EAST AVE
Practice Address - Street 2:2L
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5721
Practice Address - Country:US
Practice Address - Phone:203-853-2323
Practice Address - Fax:203-831-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD02442Medicare UPIN