Provider Demographics
NPI:1669844239
Name:LADY DOC'S LLC
Entity type:Organization
Organization Name:LADY DOC'S LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:203-612-7600
Mailing Address - Street 1:630 BROOKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1528
Mailing Address - Country:US
Mailing Address - Phone:203-612-7600
Mailing Address - Fax:203-612-7600
Practice Address - Street 1:630 BROOKLAWN AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1528
Practice Address - Country:US
Practice Address - Phone:203-612-7600
Practice Address - Fax:203-612-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
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No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty