Provider Demographics
NPI:1679734842
Name:GYNECOLOGY & OBSTETRICS OF WILTON-WESTPORT P.C.
Entity Type:Organization
Organization Name:GYNECOLOGY & OBSTETRICS OF WILTON-WESTPORT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:STORCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-226-1243
Mailing Address - Street 1:156 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2440
Mailing Address - Country:US
Mailing Address - Phone:203-226-1243
Mailing Address - Fax:203-221-5071
Practice Address - Street 1:156 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2440
Practice Address - Country:US
Practice Address - Phone:203-226-1243
Practice Address - Fax:203-221-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18631174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1186311Medicaid
CT1186311Medicaid