Provider Demographics
NPI:1609932151
Name:TOWN OF FAIRFIELD
Entity type:Organization
Organization Name:TOWN OF FAIRFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SANDS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-256-3020
Mailing Address - Street 1:725 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6684
Mailing Address - Country:US
Mailing Address - Phone:203-256-3020
Mailing Address - Fax:203-254-8850
Practice Address - Street 1:100 MONA TERRACE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6684
Practice Address - Country:US
Practice Address - Phone:203-256-3150
Practice Address - Fax:203-256-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT68VNA0052CT01OtherANTHEM
CT600000003Medicare Oscar/Certification