Provider Demographics
NPI:1295054419
Name:STAMFORD HOSPITAL
Entity type:Organization
Organization Name:STAMFORD HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-276-2270
Mailing Address - Street 1:1351 WASHINGTON BLVD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2419
Mailing Address - Country:US
Mailing Address - Phone:203-276-1000
Mailing Address - Fax:
Practice Address - Street 1:1351 WASHINGTON BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2419
Practice Address - Country:US
Practice Address - Phone:203-276-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)