Provider Demographics
NPI:1437296415
Name:ASSOCIATED FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:ASSOCIATED FAMILY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-350-4000
Mailing Address - Street 1:146 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3427
Mailing Address - Country:US
Mailing Address - Phone:860-350-4000
Mailing Address - Fax:860-355-5581
Practice Address - Street 1:146 DANBURY RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3427
Practice Address - Country:US
Practice Address - Phone:860-350-4000
Practice Address - Fax:860-355-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004104741Medicaid
CTC01279OtherPTAN
CT001289786Medicaid
CT001290858Medicaid
CTC01279OtherPTAN
CT970001339Medicare PIN
CT080000558Medicare PIN
CTD98088Medicare UPIN
CT080000557Medicare PIN