Provider Demographics
NPI:1255583647
Name:RAMIL MANSOUROV, LLC
Entity type:Organization
Organization Name:RAMIL MANSOUROV, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-644-4775
Mailing Address - Street 1:137 HOLLOW TREE RIDGE RD APT 2213
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4036
Mailing Address - Country:US
Mailing Address - Phone:203-644-4775
Mailing Address - Fax:203-547-6118
Practice Address - Street 1:235 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-2720
Practice Address - Country:US
Practice Address - Phone:203-847-2600
Practice Address - Fax:203-547-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care