Provider Demographics
NPI:1487681045
Name:SCHECHTER, JUSTIN OWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:OWEN
Last Name:SCHECHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5030
Mailing Address - Country:US
Mailing Address - Phone:203-323-7760
Mailing Address - Fax:203-973-0220
Practice Address - Street 1:22 5TH ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5030
Practice Address - Country:US
Practice Address - Phone:203-323-7760
Practice Address - Fax:203-973-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001247354Medicaid
CTC64226Medicare UPIN