Provider Demographics
NPI:1376944678
Name:NORTHEAST NATURAL MEDICINE, LLC
Entity Type:Organization
Organization Name:NORTHEAST NATURAL MEDICINE, LLC
Other - Org Name:DR. SHAWN CARNEY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:800-723-2962
Mailing Address - Street 1:19 CHURCH HILL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1651
Mailing Address - Country:US
Mailing Address - Phone:800-723-2962
Mailing Address - Fax:
Practice Address - Street 1:19 CHURCH HILL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1651
Practice Address - Country:US
Practice Address - Phone:800-723-2962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000425175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1053646323OtherNPI