Provider Demographics
NPI:1588634695
Name:NEWINGTON INTERNAL MEDICINE PRIMARY CARE,LLP
Entity Type:Organization
Organization Name:NEWINGTON INTERNAL MEDICINE PRIMARY CARE,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:KAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-665-1571
Mailing Address - Street 1:365 WILLARD AVE
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2373
Mailing Address - Country:US
Mailing Address - Phone:860-665-1571
Mailing Address - Fax:860-665-1571
Practice Address - Street 1:365 WILLARD AVE
Practice Address - Street 2:SUITE 2-D
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2373
Practice Address - Country:US
Practice Address - Phone:860-665-1571
Practice Address - Fax:860-665-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty