Organization
GENERAL PRIZE ONE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVGENIY TATAROV (OWNER)
(203) 321-2158
Entity
Organization
Contact information
Practice address
1177 HIGH RIDGE RD, STAMFORD, CT 06905-1221
(203) 321-2158
Mailing address
1177 HIGH RIDGE RD, STAMFORD, CT 06905-1221
(203) 321-2158
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
01/17/2011
Last updated
01/17/2011
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