Provider Demographics
NPI:1891982005
Name:STAMFORD ARTHRITIS CARE, LLC
Entity Type:Organization
Organization Name:STAMFORD ARTHRITIS CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-487-0280
Mailing Address - Street 1:1266 E MAIN ST
Mailing Address - Street 2:SUITE 700R
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3546
Mailing Address - Country:US
Mailing Address - Phone:203-487-0280
Mailing Address - Fax:203-487-0279
Practice Address - Street 1:1266 E MAIN ST
Practice Address - Street 2:SUITE 700R
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3546
Practice Address - Country:US
Practice Address - Phone:203-487-0280
Practice Address - Fax:203-487-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037521207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1891982005OtherORGANIZATION NPI
CTC03453OtherMEDICARE GROUP PIN
CT010037521CT01OtherBCBS PROVIDER ID
CT2V7063OtherHEALTH NET PROVIDER ID