Provider Demographics
NPI:1306971577
Name:EQUAL HEALTH CARE LLC
Entity type:Organization
Organization Name:EQUAL HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-679-0055
Mailing Address - Street 1:185 CENTER STREET
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-679-0055
Mailing Address - Fax:203-679-0060
Practice Address - Street 1:185 CENTER STREET
Practice Address - Street 2:SUITE 2A
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-679-0055
Practice Address - Fax:203-679-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G51660Medicare UPIN