JACK V. DITEODORO M.D,LLC
Managed Care Organizations in Stamford, CT

License number
Connecticut 035558
Category
Managed Care Organizations
Type
Exclusive Provider Organization
License number
Connecticut 035558
Category
Managed Care Organizations
Type
Health Maintenance Organization
License number
Connecticut 035558
Category
Managed Care Organizations
Type
Preferred Provider Organization
License number
Connecticut 035558
Category
Managed Care Organizations
Type
Point of Service
Owner
Name: DR. JACK V DITEODORO M.D.
Title: OWNER
Phone: (203) 323-6873
Address
Address
90 Morgan Steet Stuite 303, Stamford, CT 06905
National Provider ID: 1700194636
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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JACK V. DITEODORO MD LLC

90 Morgan St SUITE 303, Stamford, CT 06905

Doing business as:
Jack V Diteodoro MD
Registration:
Jun 19, 2001
Phone:
(203) 323-6873 (Phone)
State ID:
0684293
Business type:
Domestic Limited Liability Company
PHYSICIAN:
Jack Diteodoro (PHYSICIAN), 90 Morgan St SUITE 303, Stamford, CT 06905 (Mailing)
34 Lawrence Hl Rd, Stamford, CT 06903 (Physical)
Agent:
Xl Corporate Services, Inc,59 Dogwood Rd, Wethersfield, CT 06109 (Mailing)
Categories:
Family & General Practice Physicians & Surgeons, Physicians & Surgeons

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