Individual
EBTISAM FADDOUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
29 HOSPITAL PLZ STE 501, STAMFORD, CT 06902-3602
(203) 276-4400
(203) 276-4401
Mailing address
29 HOSPITAL PLZ STE 501, STAMFORD, CT 06902-3602
(203) 276-4400
(203) 276-4401
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
015255-1
NY
Other
Enumeration date
11/21/2011
Last updated
07/19/2022
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