Provider Demographics
NPI:1942480074
Name:NEIL D. STEIN, MD, LLC
Entity Type:Organization
Organization Name:NEIL D. STEIN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-232-2626
Mailing Address - Street 1:12 N MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1932
Mailing Address - Country:US
Mailing Address - Phone:860-232-2626
Mailing Address - Fax:860-233-5407
Practice Address - Street 1:12 N MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1932
Practice Address - Country:US
Practice Address - Phone:860-232-2626
Practice Address - Fax:860-233-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027253261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001272533Medicaid
CT001272533Medicaid