Organization
CT PREVENTIVE HEALTH EDGE MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SVEN KARLSSON (COO)
(917) 310-5621
Entity
Organization
Contact information
Practice address
9 W BROAD ST STE 320, STAMFORD, CT 06902-3758
(917) 310-5621
Mailing address
9 W BROAD ST STE 320, STAMFORD, CT 06902-3758
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
—
—
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
05/13/2025
Last updated
05/16/2025
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