Provider Demographics
NPI:1437347887
Name:NORWALK IMMEDIATE CARE
Entity Type:Organization
Organization Name:NORWALK IMMEDIATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:H
Authorized Official - Last Name:REZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-849-7777
Mailing Address - Street 1:345 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1547
Mailing Address - Country:US
Mailing Address - Phone:203-849-7777
Mailing Address - Fax:203-846-4477
Practice Address - Street 1:345 MAIN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1547
Practice Address - Country:US
Practice Address - Phone:203-849-7777
Practice Address - Fax:203-846-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02093Medicare PIN