Provider Demographics
NPI:1851688055
Name:MB CARE P.C.
Entity Type:Organization
Organization Name:MB CARE P.C.
Other - Org Name:MB CARE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-864-5031
Mailing Address - Street 1:96 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-0000
Mailing Address - Country:US
Mailing Address - Phone:203-864-5031
Mailing Address - Fax:630-733-2146
Practice Address - Street 1:96 MAIN ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-0000
Practice Address - Country:US
Practice Address - Phone:203-864-5031
Practice Address - Fax:630-733-2146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0444082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH31452Medicare UPIN