Provider Demographics
NPI:1376746156
Name:NORTHEAST INTERNAL MEDICINE, INC.
Entity Type:Organization
Organization Name:NORTHEAST INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IFTIKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-725-8866
Mailing Address - Street 1:126 PROSPECT ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4429
Mailing Address - Country:US
Mailing Address - Phone:401-725-8866
Mailing Address - Fax:401-725-8868
Practice Address - Street 1:126 PROSPECT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4476
Practice Address - Country:US
Practice Address - Phone:401-725-8866
Practice Address - Fax:401-725-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty