Organization
LEIF O NORDBERG MD, LLC
Active
Other names
CVW Body Design Center - Stamford, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEIF O NORDBERG M.D. (PRESIDENT)
(203) 324-1971
Entity
Organization
Contact information
Practice address
2001 W MAIN ST, SUITE 155, STAMFORD, CT 06902
(203) 324-4700
(203) 324-5691
Mailing address
2001 W MAIN ST, SUITE 155, STAMFORD, CT 06902-4501
(203) 324-1971
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
349
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
240000178
MEDICARE ID
CT
Enumeration date
03/28/2008
Last updated
08/22/2018
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