NPIMap

Organization Active NPI

TDG Connecticut PLLC

  • Dermatology Physician
  • New Haven, CT
National Provider Identifier
1245744846
Registry record updated Nov 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
TDG CONNECTICUT PLLC
Practice address
134 Park St
New Haven, CT 06511-5409
Phone
(973) 571-2121
Fax
(973) 498-0512
NPI assigned
Nov 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Simon Samaha, MDNPI 1144304536
Title
Ceo
Phone
(973) 571-2121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

134 Park St
New Haven, CT 06511-5409

Mailing address

347 Mount Pleasant Ave Ste 205
West Orange, NJ 07052-2749
Phone (973) 571-2121

National Provider Directory

National Provider Directory

Locations

250 Indian River Rd
Ste 100
Orange, CT 06477
Phone (203) 401-6378

250 Indian River Rd
Orange, CT 06477
Phone (203) 573-4849

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512000000000",
    "number": "1245744846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "347 MOUNT PLEASANT AVE STE 205",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522749",
            "telephone_number": "973-571-2121",
            "fax_number": "973-498-0512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 PARK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115409",
            "telephone_number": "973-571-2121",
            "fax_number": "973-498-0512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TDG CONNECTICUT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-20",
        "last_updated": "2017-11-30",
        "status": "A",
        "authorized_official_last_name": "SAMAHA",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "973-571-2121",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.