Diteodoro, Jack V
Diteodoro, Jack V is an sole proprietor health care provider with primary practice located at 90 Morgan St Sutie # 303, Stamford CT 06905-5466. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Diteodoro, Jack V can be contacted via phone (203) 323-6873.Contact Information
Primary practice address
90 Morgan St Sutie # 303
Stamford CT 06905-5466
Phone: (203) 323-6873
Fax: (203) 358-9775
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | 035558 | Connecticut |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 035558 | Connecticut |
Profile Details
| NPI number | 1346338837 |
|---|---|
| LBN Legal business name | Diteodoro, Jack V |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 10th, 2006 |
| Last updated | Oct 3rd, 2010 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1346338837 | NPPES |
| Connecticut | MEDICAID | 001355587 | |
| Connecticut | Other | 1700194636 |
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