Provider Demographics
NPI:1003004847
Name:PREFERRED MDCARE, LLC
Entity Type:Organization
Organization Name:PREFERRED MDCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:V
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-820-7224
Mailing Address - Street 1:144 SHADOW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1814
Mailing Address - Country:US
Mailing Address - Phone:203-820-7224
Mailing Address - Fax:203-355-9808
Practice Address - Street 1:180 TURN OF RIVER RD
Practice Address - Street 2:SUITE 8C
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1396
Practice Address - Country:US
Practice Address - Phone:203-820-7224
Practice Address - Fax:203-355-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03412Medicare PIN