Provider Demographics
NPI:1710954961
Name:CONNECTICUT OBGYN
Entity Type:Organization
Organization Name:CONNECTICUT OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-761-1234
Mailing Address - Street 1:580 BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06128
Mailing Address - Country:US
Mailing Address - Phone:860-761-1234
Mailing Address - Fax:860-528-2341
Practice Address - Street 1:580 BURNSIDE AVE
Practice Address - Street 2:STE 4
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108
Practice Address - Country:US
Practice Address - Phone:860-761-1234
Practice Address - Fax:860-528-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036874207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0368745121OtherCONNECTICARE
CT2619324OtherAETNA
CT010036874CT02OtherBLUE CROSS BLUE SHIELD
0371247003OtherSIGNA
0V9709OtherHEALTH NET
P1278544OtherOXFORD
CT00136874601OtherMEDICAID HMO
CT189162OtherMEDICAID HMO
CT00136874601OtherMEDICAID HMO