Organization
ADVANCED GYNECOLOGY & ROBOTIC SURGEY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHABNAM M KASHANI M.D (OWNER)
(203) 374-8000
Entity
Organization
Contact information
Practice address
4637 MAIN STREET, BRIDGEPORT, CT 06606-5048
(203) 374-8000
Mailing address
4637 MAIN STREET, BRIDGEPORT, CT 06606-5048
(203) 374-8000
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207VG0400X
Gynecology Physician
045088
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045088
STATE LICENSE
CT
Enumeration date
09/28/2012
Last updated
10/12/2012
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