Provider Demographics
NPI:1477206878
Name:ZADIE KENKARE INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:ZADIE KENKARE INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZADIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENKARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-421-2272
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-0604
Mailing Address - Country:US
Mailing Address - Phone:203-453-2795
Mailing Address - Fax:203-458-6367
Practice Address - Street 1:2 SAMSON ROCK DR STE 1A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3005
Practice Address - Country:US
Practice Address - Phone:203-421-2272
Practice Address - Fax:203-421-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004112257Medicaid