Provider Demographics
NPI:1285675082
Name:ANIS & MARTIN INTERNAL MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ANIS & MARTIN INTERNAL MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-644-1523
Mailing Address - Street 1:PO BOX 3136
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2036
Mailing Address - Country:US
Mailing Address - Phone:860-896-1422
Mailing Address - Fax:860-896-1425
Practice Address - Street 1:1504 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2711
Practice Address - Country:US
Practice Address - Phone:860-644-1523
Practice Address - Fax:860-648-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP00269488OtherMEDICARE RAIL ROAD NUMBER DR. ANIS
CTDB1187OtherMEDICARE RAIL ROAD
CTP00087818OtherMEDICARE RAIL ROAD NUMBER DR. MARTIN
CTP00269488OtherMEDICARE RAIL ROAD NUMBER DR. ANIS
CTDB1187OtherMEDICARE RAIL ROAD