Provider Demographics
NPI:1649331778
Name:NAUGATUCK VALLEY OBGYN
Entity type:Organization
Organization Name:NAUGATUCK VALLEY OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-575-1811
Mailing Address - Street 1:133 SCOVILL ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1127
Mailing Address - Country:US
Mailing Address - Phone:203-575-1811
Mailing Address - Fax:203-575-1995
Practice Address - Street 1:133 SCOVILL ST
Practice Address - Street 2:SUITE 303
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1127
Practice Address - Country:US
Practice Address - Phone:203-575-1811
Practice Address - Fax:203-575-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01191Medicare ID - Type Unspecified