Provider Demographics
NPI:1760923734
Name:AVON ALLIES LLC
Entity Type:Organization
Organization Name:AVON ALLIES LLC
Other - Org Name:BETTER MEDICINE CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR- CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NAUMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUFTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:860-409-9255
Mailing Address - Street 1:45 W MAIN ST
Mailing Address - Street 2:UPPER LEVEL SUITE 1
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3791
Mailing Address - Country:US
Mailing Address - Phone:860-409-9255
Mailing Address - Fax:
Practice Address - Street 1:45 W MAIN ST
Practice Address - Street 2:UPPER LEVEL SUITE 1
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3791
Practice Address - Country:US
Practice Address - Phone:860-409-9255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039306261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008047645Medicaid
CTD400050132Medicare UPIN