Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 030279 | CT |
NPI | 1225101991 |
---|---|
Provider Name | Dr. Syed Hyder Reza |
First Address | Norwalk, CT 06851-1547 |
Second Address | Norwalk, CT 06851-1547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E37219 | (02) | CT |