NPI 1700194636

Jack V. Diteodoro M.D,llc

Organisation Point of Service Stamford, CT

Practice location

Address: 90 Morgan Steet Stuite 303, Stamford, CT 06905-5436
Phone: (203) 323-6873
Mailing address: 90 Morgan St STE 303, Stamford, CT 06905-5436

Authorised official

Name: Jack V Diteodoro
Title: Owner
Phone: (203) 323-6873

Registered specialties (4)

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X Licence 035558 (CT)

Other Point of Service providers in Connecticut →

Exclusive Provider Organization

Managed Care Organizations Taxonomy 302F00000X Licence 035558 (CT)

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Health Maintenance Organization

Managed Care Organizations Taxonomy 302R00000X Licence 035558 (CT)

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Preferred Provider Organization

Managed Care Organizations Taxonomy 305R00000X Licence 035558 (CT)

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Registry record

NPI: 1700194636
Entity type: Organization
NPI issued: 14 Sep 2010
Record last updated: 14 Sep 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.