Provider Demographics
NPI:1629239751
Name:FAIRFIELD COUNTY INTEGRATIVE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:FAIRFIELD COUNTY INTEGRATIVE FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CREMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-521-3405
Mailing Address - Street 1:2 CORPORATE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1376
Mailing Address - Country:US
Mailing Address - Phone:203-445-9060
Mailing Address - Fax:203-445-9093
Practice Address - Street 1:2 CORPORATE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1376
Practice Address - Country:US
Practice Address - Phone:203-445-9060
Practice Address - Fax:203-445-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044753261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100000031Medicare PIN