Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 031959 | CT |
N | 207QA0505X | Family Doctor - Adult Medicine | 31959 | CT |
N | 207QS0010X | Family Doctor - Sports Medicine | 031959 | CT |
Y | 207R00000X | Internist | 031959 | CT |
Y | 111NI0900X | Internist | 031959 | CT |
NPI | 1740311208 |
---|---|
Provider Name | Dr. Michael Lance Gerstenfeld |
First Address | Danbury, CT 06811-5140 |
Second Address | Danbury, CT 06811-5140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 31/12/2011 |