Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack V Diteodoro M D, LLC

Organization Exclusive Provider Organization · NPI 1700194636

Jack V Diteodoro M D, LLC is an Exclusive Provider Organization in Stamford, Connecticut. Licensed in Connecticut. Registered with an NPI since 2010.

Licensed in
CT
In the registry since
2010
Specialties on file
4
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

90 Morgan Steet Stuite 303
Stamford, CT 06905-5436
Phone: (203) 323-6873
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Point of Service (primary) Taxonomy 305S00000X · Licence 035558 (CT)
Exclusive Provider Organization Taxonomy 302F00000X · Licence 035558 (CT)
Health Maintenance Organization Taxonomy 302R00000X · Licence 035558 (CT)
Preferred Provider Organization Taxonomy 305R00000X · Licence 035558 (CT)

Record details

NPI number1700194636
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jack Diteodoro — Owner · (203) 323-6873
NPI enumeratedSeptember 14, 2010
Last updated in NPPESSeptember 14, 2010
Mailing address90 Morgan St Ste 303, Stamford, CT 06905-5436

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