Provider Demographics
NPI:1598763252
Name:ADEFUIN, ZOSIMO (MD)
Entity Type:Individual
Prefix:
First Name:ZOSIMO
Middle Name:
Last Name:ADEFUIN
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 1:439 MILL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2866
Mailing Address - Country:US
Mailing Address - Phone:203-334-2100
Mailing Address - Fax:203-333-5864
Practice Address - Street 1:439 MILL HILL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2866
Practice Address - Country:US
Practice Address - Phone:203-334-2100
Practice Address - Fax:203-333-5864
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTB39548174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB39548Medicare UPIN