Provider Demographics
NPI:1942345830
Name:REGIONAL PHYSICIAN SERVICES, CT, P.C
Entity type:Organization
Organization Name:REGIONAL PHYSICIAN SERVICES, CT, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-662-4560
Mailing Address - Street 1:45 MAIN ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1000
Mailing Address - Country:US
Mailing Address - Phone:866-662-4560
Mailing Address - Fax:877-279-9425
Practice Address - Street 1:49 LEAVENWORTH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2115
Practice Address - Country:US
Practice Address - Phone:866-662-4560
Practice Address - Fax:877-279-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02827Medicare ID - Type Unspecified