Provider Demographics
NPI:1093731291
Name:BEACON FALLS MEDICAL ASSOCIATION, LLC
Entity Type:Organization
Organization Name:BEACON FALLS MEDICAL ASSOCIATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ORELLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-729-6644
Mailing Address - Street 1:202 WATER ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-2803
Mailing Address - Country:US
Mailing Address - Phone:203-729-6644
Mailing Address - Fax:
Practice Address - Street 1:202 WATER ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-2803
Practice Address - Country:US
Practice Address - Phone:203-729-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035834207RG0100X
CT035801207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCG6464OtherRAILROAD MEDICARE
CT50BEFALLSCT01OtherANTHEM BC/BS
CTC02622Medicare ID - Type Unspecified