DR. IRA D MICKENBERG (NPI# 1285680751) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285680751 |
| Entity Type | Individual |
| Full Name | DR. IRA D MICKENBERG |
| Credential | M.D. |
| Practice Address |
22 Old Waterbury Rd Suite 201 Southbury CT 06488-3848 |
| Practice Telephone | 2032646503 |
| Practice Fax Number | 2032621430 |
| Mailing Telephone | 2032646503 |
| Mailing Fax Number | 2032621430 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
014557 | CT | Allopathic & Osteopathic Physicians |
| Street Address |
22 OLD WATERBURY RD SUITE 201 |
| City | SOUTHBURY |
| State | CT |
| Zip Code | 06488-3848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912952243 | Heather M Nisbeth | Internal Medicine | 22 Old Waterbury Rd, Suite 201, Southbury, CT 06488-3848 | 2006-05-24 |
| 1972125540 | Heather Fleming | Physical Therapist | 22 Old Waterbury Rd, Southbury, CT 06488-3848 | 2020-05-17 |
| 1114483138 | Susanna Carlson | Social Worker | 22 Old Waterbury Rd, Southbury, CT 06488-3848 | 2019-02-14 |
| 1174987481 | Catherine G Winkler | Nurse Practitioner | 22 Old Waterbury Rd, Southbury, CT 06488-3848 | 2016-04-12 |
| 1780013854 | The Eye Care Group, PC | Eyewear Supplier (Equipment, not the service) | 22 Old Waterbury Rd, Suite 202, Southbury, CT 06488-3848 | 2013-11-08 |
| 1275806390 | Kristen L Velsmid | Nurse Practitioner | 22 Old Waterbury Rd, Suite 203, Southbury, CT 06488-3848 | 2012-02-21 |
| 1851578660 | Jonathan Mosovich | Internal Medicine | 22 Old Waterbury Rd, Suite 201, Southbury, CT 06488-3848 | 2008-01-23 |
| 1972785608 | Dileema Kalansuriya | Internal Medicine | 22 Old Waterbury Rd, Suite 108, Southbury, CT 06488-3848 | 2007-12-05 |
| 1114148558 | Agata Jaskiewicz-poznanska | Family Medicine | 22 Old Waterbury Rd, Southbury, CT 06488-3848 | 2007-05-02 |
| 1407984222 | Southbury Medical Associates, LLP | Internal Medicine | 22 Old Waterbury Rd, Suite 201, Southbury, CT 06488-3848 | 2007-03-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538646229 | Katherine Whalen | Physical Therapist | 655 Main Sreet South, Southbury, CT 06488 | 2018-07-25 |
| 1346779618 | Prestige Companion & Homemakers, LLC | Homemaker | 32 Poverty Rd, Suite F, Southbury, CT 06488 | 2017-06-08 |
| 1407225873 | Mary Synnott | Occupational Therapist | 25 Depot Hill Rd, Southbuty, CT 06488 | 2015-09-16 |
| 1568854735 | Jean Piacenza | Social Worker | 505 Heritage Road, Suite 104, Southbury, CT 06488 | 2015-02-25 |
| 1295174993 | Saeeda Qadri | Internal Medicine | 22 Old Waterbury Rd Ste 108, Southbury, CT 06488 | 2013-06-17 |
| 1538502133 | Hearing Aid Services Inc | Audiologist-Hearing Aid Fitter | 1449 Old Waterbury Rd Ste 303, Southbury, CT 06488 | 2013-04-12 |
| 1992064380 | Maria Hornak-houle | Social Worker | 88 Main St. S, Southbury, CT 06488 | 2012-05-07 |
| 1255641072 | Rebecha Kay Sullivan | Social Worker | 35 Timberland Way, Southbury, CT 06488 | 2010-10-14 |
| 1619115094 | Jennie L Kempf | Counselor | 33 Bullet Hill Rd Ste 204, Southbury, CT 06488 | 2009-01-23 |
| 1891949434 | Kelly Patrice Hochstetler | Occupational Therapist | 22 Old Waterbury Rd., Suite 101, Phys. Med. Ctr. of Southbury, Southbury, CT 06488 | 2008-11-10 |
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| Taxonomy Code | 207RI0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Infectious Disease |
| An internist who deals with infectious diseases of all types and in all organ systems. Conditions requiring selective use of antibiotics call for this special skill. This physician often diagnoses and treats AIDS patients and patients with fevers which have not been explained. Infectious disease specialists may also have expertise in preventive medicine and travel medicine. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972861896 | Peter J Piliero | Internal Medicine | 625 Patriot Rd, Southbury, CT 06488-3223 | 2012-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336768944 | Michael William Dunne | Internal Medicine | 30 Cromwell Pl, Old Saybrook, CT 06475-2512 | 2020-04-14 |
| 1548673627 | Scott Roberts | Internal Medicine | 789 Howard Ave # 3, New Haven, CT 06519-1304 | 2014-06-06 |
| 1568702629 | Infectious Disease Consultancy, LLC | Internal Medicine | 9 Hickory Ln, Woodbridge, CT 06525-1433 | 2013-02-26 |
| 1730443698 | Roger Madison Echols | Internal Medicine | 753 Westport Rd, Easton, CT 06612-1535 | 2012-06-26 |
| 1750642930 | Daniel Alfred Scott | Internal Medicine | 63 Ridgecrest Dr, Ridgefield, CT 06877-2534 | 2012-06-04 |
| 1710243167 | Robert Gordon Douglas Jr. | Internal Medicine | 265 Old Black Point Rd, Niantic, CT 06357-3732 | 2012-04-10 |
| 1780979526 | Marwan Azar | Internal Medicine | 300 Cedar St # S169, New Haven, CT 06519-1612 | 2011-06-09 |
| 1730415928 | Stephanie Green | Internal Medicine | 54 Meadow St Fl 1, New Haven, CT 06519-1719 | 2009-10-23 |
| 1811129463 | Jeanne Demars Breen | Internal Medicine | 229 Hidden Cove Rd, Old Saybrook, CT 06475-1620 | 2009-08-17 |
| 1154555738 | Robert Steven Wallis | Internal Medicine | 55 Saunders Hollow Rd, Old Lyme, CT 06371-1127 | 2009-05-11 |
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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.