Provider Demographics
NPI:1104960111
Name:NEW ENGLAND CARDIOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:NEW ENGLAND CARDIOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-643-5102
Mailing Address - Street 1:257 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5214
Mailing Address - Country:US
Mailing Address - Phone:860-643-5102
Mailing Address - Fax:
Practice Address - Street 1:257 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5214
Practice Address - Country:US
Practice Address - Phone:860-643-5102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001175Medicare ID - Type UnspecifiedSAQIB NASEERS NUMBER