Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 020108 | CT |
NPI | 1013901602 |
---|---|
Provider Name | Dr. Igal Staw |
First Address | Fairfield, CT 06824-5730 |
Second Address | Fairfield, CT 06824-5730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 28/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B38323 | (02) | CT |