Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 055653 | CT |
NPI | 1083671861 |
---|---|
Provider Name | Dr. Taimur Habib |
First Address | Bridgeport, CT 06610-2826 |
Second Address | Bridgeport, CT 06610-2826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 06/03/2017 |