Provider Demographics
NPI:1699954164
Name:JUSTIN O SCHECHTER M D
Entity type:Organization
Organization Name:JUSTIN O SCHECHTER M D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:SCHECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-323-7760
Mailing Address - Street 1:22 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5030
Mailing Address - Country:US
Mailing Address - Phone:203-323-7760
Mailing Address - Fax:203-973-0220
Practice Address - Street 1:22 5TH ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5030
Practice Address - Country:US
Practice Address - Phone:203-323-7760
Practice Address - Fax:203-973-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C64226Medicare UPIN
C01203Medicare UPIN