Provider Demographics
NPI:1275225864
Name:VISAVIS HEALTH CARE MEDICAL GROUP OF CT LLC
Entity Type:Organization
Organization Name:VISAVIS HEALTH CARE MEDICAL GROUP OF CT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANDARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-534-0689
Mailing Address - Street 1:250 SKILLMAN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1218
Mailing Address - Country:US
Mailing Address - Phone:718-534-0689
Mailing Address - Fax:
Practice Address - Street 1:1 EMILY WAY
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3136
Practice Address - Country:US
Practice Address - Phone:718-534-0689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty