Provider Demographics
NPI:1164488177
Name:DANBURY INTERNAL MEDICINE ASSOCIATES PROF CORP
Entity Type:Organization
Organization Name:DANBURY INTERNAL MEDICINE ASSOCIATES PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-830-4607
Mailing Address - Street 1:16 HOSPITAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5927
Mailing Address - Country:US
Mailing Address - Phone:203-830-4607
Mailing Address - Fax:203-743-8096
Practice Address - Street 1:16 HOSPITAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5927
Practice Address - Country:US
Practice Address - Phone:203-830-4607
Practice Address - Fax:203-743-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004000857Medicaid
CT004000857Medicaid
CT=========OtherTAX ID