Provider Demographics
NPI:1467851162
Name:ALEJANDRO E ISGUT MD LLC
Entity Type:Organization
Organization Name:ALEJANDRO E ISGUT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ISGUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-270-1077
Mailing Address - Street 1:153 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2791
Mailing Address - Country:US
Mailing Address - Phone:203-270-1077
Mailing Address - Fax:
Practice Address - Street 1:153 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2791
Practice Address - Country:US
Practice Address - Phone:203-270-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016010208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1144287913OtherINDIVIDUAL NPI
CT14950OtherCDS
080000822OtherMEDICARE ID
080000822OtherMEDICARE ID