Provider Demographics
NPI:1295929230
Name:ENDOCRINE ASSOC OF CT LLC
Entity type:Organization
Organization Name:ENDOCRINE ASSOC OF CT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAYERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-776-4444
Mailing Address - Street 1:1952 WHITNEY AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-1209
Mailing Address - Country:US
Mailing Address - Phone:203-776-4444
Mailing Address - Fax:203-776-4441
Practice Address - Street 1:1952 WHITNEY AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1209
Practice Address - Country:US
Practice Address - Phone:203-776-4444
Practice Address - Fax:203-776-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02736Medicare PIN