Provider Demographics
NPI:1740226885
Name:MEDICAL ASSOCIATES OF STAMFORD PC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF STAMFORD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-323-4458
Mailing Address - Street 1:1100 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5305
Mailing Address - Country:US
Mailing Address - Phone:203-323-4458
Mailing Address - Fax:203-352-4663
Practice Address - Street 1:1100 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5305
Practice Address - Country:US
Practice Address - Phone:203-323-4458
Practice Address - Fax:203-352-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004002705Medicaid
CT004002705Medicaid