Provider Demographics
NPI:1942492293
Name:HIGH RIDGE FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:HIGH RIDGE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:FALKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-322-7070
Mailing Address - Street 1:30 BUXTON FARMS ROAD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1224
Mailing Address - Country:US
Mailing Address - Phone:203-322-7070
Mailing Address - Fax:203-322-2389
Practice Address - Street 1:30 BUXTON FARMS ROAD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1224
Practice Address - Country:US
Practice Address - Phone:203-322-7070
Practice Address - Fax:203-322-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCO2701Medicare PIN