Provider Demographics
NPI:1609092121
Name:INTERNAL MEDICINE AND INFECTIOUS DISEASE ASSOCIATED P.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AND INFECTIOUS DISEASE ASSOCIATED P.C.
Other - Org Name:INTERNAL MEDICINE AND INFECTIOUS DISEASE ASSOC P. C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-383-4466
Mailing Address - Street 1:3241 MAIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614
Mailing Address - Country:US
Mailing Address - Phone:203-383-4466
Mailing Address - Fax:203-383-4499
Practice Address - Street 1:3241 MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614
Practice Address - Country:US
Practice Address - Phone:203-383-4466
Practice Address - Fax:203-383-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02852OtherMEDICARE PTAN
CT4223872Medicaid
CT88817OtherAETNA