Provider Demographics
NPI:1629330220
Name:CONNECTICUT REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY, PC
Entity Type:Organization
Organization Name:CONNECTICUT REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-200-7117
Mailing Address - Street 1:3810 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-2039
Mailing Address - Country:US
Mailing Address - Phone:203-292-6049
Mailing Address - Fax:203-916-6912
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:SUITE 107B
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6337
Practice Address - Country:US
Practice Address - Phone:203-200-7117
Practice Address - Fax:203-916-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043549207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty