Provider Demographics
NPI:1861691362
Name:SOUTHERN CONNECTICUT WOMENS HEALTH CARE ASSOCIATES
Entity type:Organization
Organization Name:SOUTHERN CONNECTICUT WOMENS HEALTH CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YORAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LIRTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-783-0543
Mailing Address - Street 1:247 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-783-0543
Mailing Address - Fax:203-874-5728
Practice Address - Street 1:247 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3267
Practice Address - Country:US
Practice Address - Phone:203-783-0543
Practice Address - Fax:203-874-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004237112Medicaid
CT004237112Medicaid