Stony Creek Medical Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

041818 Issued in CT

Legal business name

STONY CREEK MEDICAL GROUP, LLC

Practice address

236 Boston Post Rd
Orange, CT 06477-3236

Phone

(203) 815-1054

Fax

(203) 298-9874

NPI assigned

Oct 18, 2013

Organization subpart

No

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

Authorized official

Name

Mayumi Deanna Noda Young

Title

Executive Director

Phone

(203) 483-4580

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1382054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382400000000",
    "number": "1609204122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 BUSINESS PARK DR",
            "address_2": "SUITE 302",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064052988",
            "telephone_number": "203-980-1359",
            "fax_number": "203-483-4581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 BOSTON POST RD",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773236",
            "telephone_number": "203-815-1054",
            "fax_number": "203-298-9874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY CREEK MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-18",
        "last_updated": "2013-10-22",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "MAYUMI DEANNA",
        "authorized_official_middle_name": "NODA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "203-483-4580"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "042996",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "041818",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "041818",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Soto, SPEECH THERAPIST
• Hayley Spragg
• Sofia Stafford
• Alexander D. Stanton, MD
• Sterling Medical LLC
• Cora Stover, N.D.
• Nicole Potucek Strand, NP-C
• Yvonne Su, DDS
• Katherine Sullivan, DPT
• Nicole Cassista Surin, DPT

• Internal Medicine Physician in Orange, CT
• Providers in Orange, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2013; 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.