Provider Demographics
NPI:1548569718
Name:AVON ALLIES LLC
Entity Type:Organization
Organization Name:AVON ALLIES LLC
Other - Org Name:ALLIES MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAUMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUFTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-678-9900
Mailing Address - Street 1:2 BRIDGEWATER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2269
Mailing Address - Country:US
Mailing Address - Phone:860-678-9900
Mailing Address - Fax:
Practice Address - Street 1:2 BRIDGEWATER RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2269
Practice Address - Country:US
Practice Address - Phone:860-678-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039306261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center