Provider Demographics
NPI:1962452318
Name:FLOCH, NEIL
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:FLOCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 EAST AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5721
Mailing Address - Country:US
Mailing Address - Phone:203-899-0744
Mailing Address - Fax:
Practice Address - Street 1:148 EAST AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5721
Practice Address - Country:US
Practice Address - Phone:203-899-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036870208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT020001446Medicare ID - Type Unspecified
CTF85364Medicare UPIN