Provider Demographics
NPI:1689669384
Name:CITY OF NEW LONDON
Entity Type:Organization
Organization Name:CITY OF NEW LONDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-447-5291
Mailing Address - Street 1:269 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2302
Mailing Address - Country:US
Mailing Address - Phone:860-638-1800
Mailing Address - Fax:860-638-1802
Practice Address - Street 1:289 BANK ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5521
Practice Address - Country:US
Practice Address - Phone:860-447-5291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004072500Medicaid
710C095A2CT01OtherBLUE CROSS/BLUE SHIELD
CT0476OtherHEALTHNET
590069399OtherRAILROAD MEDICARE
590069399OtherRAILROAD MEDICARE