Endocrinology Asscociates of Southern CT, LLC

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

041464 Issued in CT

Legal business name

ENDOCRINOLOGY ASSCOCIATES OF SOUTHERN CT, LLC

Practice address

3715 Main St
Bridgeport, CT 06606-3611

Phone

(203) 372-4636

Fax

(203) 372-4188

NPI assigned

Oct 1, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael Duben, MD

Title

Owner

Phone

(203) 372-4636

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254182400000",
    "number": "1760679054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066063618",
            "telephone_number": "203-372-4636",
            "fax_number": "203-372-4188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3715 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066063611",
            "telephone_number": "203-372-4636",
            "fax_number": "203-372-4188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDOCRINOLOGY ASSCOCIATES OF SOUTHERN CT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-01",
        "last_updated": "2009-09-29",
        "status": "A",
        "authorized_official_last_name": "DUBEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-372-4636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CT",
            "license": "041464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endocrinology, Diabetes & Metabolism Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Endocrinology, Diabetes & Metabolism Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; 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.