Provider Demographics
NPI:1497861140
Name:SEKERAK M.D. & TRISTINE M.D., PC
Entity Type:Organization
Organization Name:SEKERAK M.D. & TRISTINE M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SEKERAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-371-8000
Mailing Address - Street 1:5520 PARK AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3463
Mailing Address - Country:US
Mailing Address - Phone:203-371-8000
Mailing Address - Fax:203-371-8006
Practice Address - Street 1:5520 PARK AVE
Practice Address - Street 2:SUITE208
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3463
Practice Address - Country:US
Practice Address - Phone:203-371-8000
Practice Address - Fax:203-371-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004205193Medicaid
CT004205193Medicaid