Provider Demographics
NPI:1427246347
Name:CT FERTILITY, PC
Entity type:Organization
Organization Name:CT FERTILITY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-373-1200
Mailing Address - Street 1:100 TECHNOLOGY DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6303
Mailing Address - Country:US
Mailing Address - Phone:203-373-1200
Mailing Address - Fax:203-416-5445
Practice Address - Street 1:100 TECHNOLOGY DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6303
Practice Address - Country:US
Practice Address - Phone:203-373-1200
Practice Address - Fax:203-416-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty