Individual
DR. MARK JAY GANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2228 BLACK ROCK TPKE, SUITE 310, FAIRFIELD, CT 06825-3237
(203) 336-4264
(203) 336-4265
Mailing address
2228 BLACK ROCK TPKE, SUITE 310, FAIRFIELD, CT 06825-3237
(203) 336-4264
(203) 336-4265
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
562
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060000562CT04
BLUE CROSS
CT
01
—
173505
MANAGED HEALTH NETWORK
CT
01
—
6129154
UNITED HEALTHCARE
CT
01
—
ZS555
OXFORD
CT
Enumeration date
07/21/2006
Last updated
07/08/2007
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