Jack V. Diteodoro M.D,Llc

LBN: Jack V. Diteodoro M.D,Llc
Jack V. Diteodoro M.D,Llc is an health care organization with primary practice located at 90 Morgan Steet Stuite 303 , Stamford CT 06905-5436. The organization recently has 4 registered licenses in different health care specialties including Managed Care Organizations / Exclusive Provider Organization, Managed Care Organizations / Health Maintenance Organization, Managed Care Organizations / Preferred Provider Organization, Managed Care Organizations / Point of Service. Managed Care Organizations / Point of Service is the primary health care specialty. Jack V. Diteodoro M.D,Llc can be contacted via phone (203) 323-6873, or through Diteodoro, Jack V via phone (203) 323-6873.

Contact Information

Primary practice address
90 Morgan Steet Stuite 303 Stamford CT 06905-5436
Phone: (203) 323-6873
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Diteodoro, Jack V Doctor of Medicine (MD)
Phone: (203) 323-6873

Health care specialties

SpecialtyCodeLicense #State
Managed Care Organizations / Exclusive Provider Organization 302F00000X 035558 Connecticut
Managed Care Organizations / Health Maintenance Organization 302R00000X 035558 Connecticut
Managed Care Organizations / Preferred Provider Organization 305R00000X 035558 Connecticut
Managed Care Organizations / Point of Service 305S00000X 035558 Connecticut

Profile Details

NPI number 1700194636
LBN Legal business name Jack V. Diteodoro M.D,Llc
DBA Doing business as
Authorized official Diteodoro, Jack V Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Sep 14th, 2010
Last updated Sep 14th, 2010 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700194636 NPPES
Connecticut MEDICAID 001355587

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