Provider Demographics
NPI:1891727673
Name:ASSOCIATED PHYSICIANS OF SOUTHBURY, PC
Entity Type:Organization
Organization Name:ASSOCIATED PHYSICIANS OF SOUTHBURY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:TRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-264-3319
Mailing Address - Street 1:385 MAIN ST S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488
Mailing Address - Country:US
Mailing Address - Phone:203-264-3319
Mailing Address - Fax:203-267-6382
Practice Address - Street 1:385 MAIN ST S
Practice Address - Street 2:SUITE 301
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488
Practice Address - Country:US
Practice Address - Phone:203-264-3319
Practice Address - Fax:203-267-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02303Medicare PIN