Provider Demographics
NPI:1568510865
Name:HIGH RIDGE INT & WOMENS MEDICINE
Entity Type:Organization
Organization Name:HIGH RIDGE INT & WOMENS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-604-1670
Mailing Address - Street 1:153 EAST AVE
Mailing Address - Street 2:STE 35
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5711
Mailing Address - Country:US
Mailing Address - Phone:203-604-1670
Mailing Address - Fax:203-604-1673
Practice Address - Street 1:153 EAST AVE
Practice Address - Street 2:STE 35
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5711
Practice Address - Country:US
Practice Address - Phone:203-604-1670
Practice Address - Fax:203-604-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03395Medicare ID - Type UnspecifiedGROUP MEDICARE ID