Provider Demographics
NPI:1871656355
Name:MANUAL MEDICINE OF NEW ENGLAND, LLC
Entity Type:Organization
Organization Name:MANUAL MEDICINE OF NEW ENGLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-228-1119
Mailing Address - Street 1:105 MAIN ST
Mailing Address - Street 2:PO BOX 636
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-1519
Mailing Address - Country:US
Mailing Address - Phone:860-228-1119
Mailing Address - Fax:860-228-4314
Practice Address - Street 1:105 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-1519
Practice Address - Country:US
Practice Address - Phone:860-228-1119
Practice Address - Fax:860-228-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty