Provider Demographics
NPI:1396186144
Name:NORWALK INTEGRATED MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:NORWALK INTEGRATED MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MURCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-845-0400
Mailing Address - Street 1:365 WESTPORT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4344
Mailing Address - Country:US
Mailing Address - Phone:203-845-0400
Mailing Address - Fax:203-845-0005
Practice Address - Street 1:365 WESTPORT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4344
Practice Address - Country:US
Practice Address - Phone:203-845-0400
Practice Address - Fax:203-845-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001913111N00000X
CT031959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty