Provider Demographics
NPI:1457840381
Name:SANITAS OF CONNECTICUT LLC
Entity Type:Organization
Organization Name:SANITAS OF CONNECTICUT LLC
Other - Org Name:SANITAS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:DARSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-470-2948
Mailing Address - Street 1:4551 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1818
Mailing Address - Country:US
Mailing Address - Phone:203-290-3800
Mailing Address - Fax:
Practice Address - Street 1:196 KITTS LN
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4250
Practice Address - Country:US
Practice Address - Phone:203-290-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANITAS OF CONNECTICUT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty