Provider Demographics
NPI:1659393775
Name:HOSPITAL INTERNISTS OF NEW LONDON, LLC
Entity Type:Organization
Organization Name:HOSPITAL INTERNISTS OF NEW LONDON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF HOSPITALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:SHUSHTARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-442-0711
Mailing Address - Street 1:365 MONTAUK AVE
Mailing Address - Street 2:ROOM 4.512
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4700
Mailing Address - Country:US
Mailing Address - Phone:860-442-0711
Mailing Address - Fax:860-444-5114
Practice Address - Street 1:365 MONTAUK AVE
Practice Address - Street 2:ROOM 4.512
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4700
Practice Address - Country:US
Practice Address - Phone:860-442-0711
Practice Address - Fax:860-444-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK7876OtherRAILROAD
CTC03039Medicare ID - Type Unspecified