Provider Demographics
NPI:1730134305
Name:NORTHEASTERN PULMONARY ASSOCIATES LLC
Entity Type:Organization
Organization Name:NORTHEASTERN PULMONARY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:SAUD
Authorized Official - Last Name:ANWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-875-2444
Mailing Address - Street 1:27 NAEK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3942
Mailing Address - Country:US
Mailing Address - Phone:860-875-2444
Mailing Address - Fax:860-872-2936
Practice Address - Street 1:27 NAEK ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:860-875-2444
Practice Address - Fax:860-872-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004395275OtherSTATE WELFARE, EDS PROGRA
CTC01104Medicare ID - Type Unspecified