Individual
DR. IRA JEFFREY DEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
160 HAWLEY LN, TRUMBULL, CT 06611-5300
(203) 377-0111
Mailing address
160 HAWLEY LN, TRUMBULL, CT 06611-5300
(203) 377-0111
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
23977
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23977
MEDICAL LICENSE NUMBER
CT
Enumeration date
11/29/2006
Last updated
07/08/2007
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