Provider Demographics
NPI:1114762119
Name:ANGELO MALLOZZI ,MD, PC
Entity type:Organization
Organization Name:ANGELO MALLOZZI ,MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-273-6311
Mailing Address - Street 1:90 MORGAN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5436
Mailing Address - Country:US
Mailing Address - Phone:203-273-6311
Mailing Address - Fax:
Practice Address - Street 1:90 MORGAN ST STE 102
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5436
Practice Address - Country:US
Practice Address - Phone:203-273-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care