JACK V. DITEODORO M.D,LLC (NPI# 1700194636) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700194636 |
| Entity Type | Organization |
| Organization Name | JACK V. DITEODORO M.D,LLC |
| Practice Address |
90 Morgan Steet Stuite 303 Stamford CT 06905-5436 |
| Mailing Address |
90 Morgan St Ste 303 Stamford CT 06905-5436 |
| Practice Telephone | 2033236873 |
| Mailing Telephone | 2033236873 |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2010-09-14 |
| Authorized Official Name | DR. JACK V DITEODORO (OWNER) |
| Authorized Official Telephone | 2033236873 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 302F00000X | Exclusive Provider Organization | 035558 | CT | Managed Care Organizations |
| N | 302R00000X | Health Maintenance Organization | 035558 | CT | Managed Care Organizations |
| N | 305R00000X | Preferred Provider Organization | 035558 | CT | Managed Care Organizations |
| Y | 305S00000X | Point of Service | 035558 | CT | Managed Care Organizations |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 001355587 | 05 |
| Street Address |
90 MORGAN STEET STUITE 303 |
| City | STAMFORD |
| State | CT |
| Zip Code | 06905-5436 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396367272 | Smartport LLC | Non-emergency Medical Transport (VAN) | C/o Mollo, 1111 Summer St, Stamford, CT 06905 | 2020-05-13 |
| 1245889096 | Anna Diamantis | Counselor | 1200 High Ridge Road, 2nd Floor, Stamford, CT 06905 | 2019-09-04 |
| 1871150409 | Connecticut Anesthesia Associates LLC | Anesthesiology | 1177 High Ridge Road, Stamford, CT 06905 | 2019-05-20 |
| 1518447887 | Alexandra Petrov | Lactation Consultant, Non-RN | 42 Riverside Ave, Stamford, CT 06905 | 2018-08-16 |
| 1235640327 | A&s Chemists LLC | Pharmacy | 910 Summer Ave, Stamford, CT 06905 | 2017-10-17 |
| 1659805117 | Evolution Physical Therapy, LLC | Clinic/Center | 7 Reynolds Ave, Stamford, CT 06905 | 2017-04-11 |
| 1326587841 | Karen Poggi | Speech-Language Pathologist | 30 Buxton Farm Rd., Suite 230, Stamford, CT 06905 | 2017-02-16 |
| 1811434871 | Christina Skuburids, LLC | Point of Service | 2043 Bedford Street, Stamford, CT 06905 | 2017-01-27 |
| 1669833513 | Christian Alvarez | Occupational Therapist | 15 First St Unit 1, Stamford, CT 06905 | 2016-03-18 |
| 1932500915 | Emily Krol | Psychologist | 29 Yale Court, Stamford, CT 06905 | 2014-09-10 |
| Find all providers in zip 06905 | ||||
| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790328755 | Parkhill Health Services | Point of Service | 281 Tresser Blvd Ste 1505, Stamford, CT 06901-3281 | 2019-10-22 |
| 1811434871 | Christina Skuburids, LLC | Point of Service | 2043 Bedford Street, Stamford, CT 06905 | 2017-01-27 |
| 1902107469 | Stamford Chiropractic & Rehab Center, LLC | Point of Service | 999 Summer St Ste 204, Stamford, CT 06905-5513 | 2010-11-15 |
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| 1942685573 | Connecticut Companions and Homecare Services LLC. | Point of Service | 2490 Black Rock Tpke, Fairfield, CT 06825-2400 | 2015-07-24 |
| 1992184931 | Dr Zhus Wound Care | Point of Service | 1271 Flanders Rd, Southington, CT 06489-1614 | 2015-05-22 |
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| 1215279948 | Pharmatiya Healthcare | Point of Service | 86 Robert Treat Drive, A, Milford, CT 06460 | 2013-03-20 |
| 1245578475 | Petalu'da Autism Services LLC | Point of Service | 6 Elizabeth Ln, Vernon, CT 06066-5056 | 2013-01-23 |
| 1326292590 | Shady Oaks Assisted Living, LLC | Point of Service | 344 Stevens St, Bristol, CT 06010-2769 | 2008-11-13 |
| 1942734314 | Anastasia Teterichko | Point of Service | 263 Farmington Avenue, Farmington, CT 06030 | 2017-04-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.