Provider Demographics
NPI:1902195019
Name:CONNECTICUT EPILEPSY GROUP PC
Entity Type:Organization
Organization Name:CONNECTICUT EPILEPSY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANCMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-428-3651
Mailing Address - Street 1:690 N BROADWAY
Mailing Address - Street 2:SUITE GL1
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2417
Mailing Address - Country:US
Mailing Address - Phone:914-428-3651
Mailing Address - Fax:914-428-2948
Practice Address - Street 1:733 SUMMER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1081
Practice Address - Country:US
Practice Address - Phone:914-428-3651
Practice Address - Fax:914-428-2948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty