Provider Demographics
NPI:1518051002
Name:ORANGE INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:ORANGE INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:AZIM
Authorized Official - Middle Name:SALIM
Authorized Official - Last Name:FAHMI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:203-795-3617
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-0762
Mailing Address - Country:US
Mailing Address - Phone:203-795-3617
Mailing Address - Fax:203-795-3618
Practice Address - Street 1:240 INDIAN RIVER RD
Practice Address - Street 2:SUITE C2
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3649
Practice Address - Country:US
Practice Address - Phone:203-795-3617
Practice Address - Fax:203-795-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C3190Medicare PIN