Nova Vita Medical PC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

50553 Issued in CT

Legal business name

NOVA VITA MEDICAL PC

Practice address

3180 Main St
Bridgeport, CT 06606

Phone

(203) 870-1616

Fax

(203) 870-1615

NPI assigned

Nov 13, 2017

Organization subpart

No

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

Authorized official

Name

Ubong Jackson Udoyen

Title

MD

Phone

(203) 870-1616

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1659884690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064237",
            "telephone_number": "203-870-1616",
            "fax_number": "203-870-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3180 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "06606",
            "telephone_number": "203-870-1616",
            "fax_number": "203-870-1615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA VITA MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-13",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "UDOYEN",
        "authorized_official_first_name": "UBONG",
        "authorized_official_middle_name": "JACKSON",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "203-870-1616"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "50553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "50553",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Paul Barry Nussbaum, M.D.

• Psychiatry Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Psychiatry Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.