Individual
DJOSER MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 HOSPITAL PLZ, STAMFORD, CT 06902-3602
(203) 276-7777
Mailing address
263 FAMINGTON AVENUE, FARMINGTON, CT 06030-1921
(860) 679-2147
(860) 679-4624
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
1.078244
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2021
Last updated
06/24/2024
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