Provider Demographics
NPI:1558896431
Name:BRIDGEPORT HOSPITAL
Entity Type:Organization
Organization Name:BRIDGEPORT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRY RESIDENCY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CEASAR
Authorized Official - Middle Name:
Authorized Official - Last Name:IRBY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-384-3998
Mailing Address - Street 1:6150 STUMPH RD APT 204
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1872
Mailing Address - Country:US
Mailing Address - Phone:216-339-8370
Mailing Address - Fax:
Practice Address - Street 1:6150 STUMPH RD APT 204
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1872
Practice Address - Country:US
Practice Address - Phone:216-339-8370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital