Provider Demographics
NPI:1699026724
Name:ADVANCED GYNECOLOGY & ROBOTIC SURGEY, LLC
Entity Type:Organization
Organization Name:ADVANCED GYNECOLOGY & ROBOTIC SURGEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHABNAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:KASHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-374-8000
Mailing Address - Street 1:4637 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5048
Mailing Address - Country:US
Mailing Address - Phone:203-374-8000
Mailing Address - Fax:
Practice Address - Street 1:4637 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5048
Practice Address - Country:US
Practice Address - Phone:203-374-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
CT045088207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT045088OtherSTATE LICENSE