Medical Specialists of Fairfield, LLC

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

Legal business name

MEDICAL SPECIALISTS OF FAIRFIELD, LLC

Doing business as

SWIM Hematology Oncology

Practice address

2800 Main St
3Rd FLR
Bridgeport, CT 06606-4201

Phone

(203) 382-2475

Fax

(203) 382-2488

NPI assigned

Jan 6, 2006

Organization subpart

No

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

Authorized official

Name

Glen Reznikoff, MD

Title

Managing Partner

Phone

(203) 255-4545

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• SWIM Hematology Oncology Doing business as

Tax ID family

Medical Specialists of Fairfield LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Medical Specialists of Fairfield, LLC

  • Hematology & Oncology Physician
  • Fairfield, CT
  • NPI 1144303892
  NPD tax ID

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397606400000",
    "number": "1700864097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 POST RD",
            "address_2": "SOUTH LOBBY",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246232",
            "telephone_number": "203-255-4545",
            "fax_number": "203-254-1191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 MAIN ST",
            "address_2": "3RD FLR",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064201",
            "telephone_number": "203-382-2475",
            "fax_number": "203-382-2488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL SPECIALISTS OF FAIRFIELD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2014-04-16",
        "status": "A",
        "authorized_official_last_name": "REZNIKOFF",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "203-255-4545",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CT",
            "identifier": "010013862CT01",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004082666",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "104363800",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NY",
            "identifier": "S2G58",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SWIM Hematology Oncology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elana Chloe McTavish, PA-C
• Mitchell S McTavish, PA-C
• Medi Spark LLC
• Rafael Mediavilla, M.S-ESL
• Medical Center Pharmacy and Home Care Center, Inc.
• Julia Emma Medina, PA-C
• Anjali Mehta, MD
• Saloni Yogesh Mehta, MBBS
• Frances Marie Mejia, MD
• Meldcare PLLC

• Hematology & Oncology Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Hematology & Oncology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2014; 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.