Provider Demographics
NPI:1366497299
Name:MERIDEN HEALTH CARE LLC
Entity Type:Organization
Organization Name:MERIDEN HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-238-3788
Mailing Address - Street 1:834 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4364
Mailing Address - Country:US
Mailing Address - Phone:203-238-3788
Mailing Address - Fax:203-238-3790
Practice Address - Street 1:834 BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4364
Practice Address - Country:US
Practice Address - Phone:203-238-3788
Practice Address - Fax:203-238-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042588207Q00000X
CT046516207Q00000X
CT033904208000000X
CT031248208000000X
CT0033368363LF0000X
CT4217363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004247236Medicaid
370001734Medicare PIN
080001896Medicare PIN
080001697Medicare PIN
CTC03185Medicare ID - Type Unspecified