Provider Demographics
NPI:1891994083
Name:FAMILY HEALTH CARE CENTER OF NEWTOWN, LLC
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE CENTER OF NEWTOWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:AFSHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-426-1818
Mailing Address - Street 1:19 CHURCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1651
Mailing Address - Country:US
Mailing Address - Phone:203-426-1818
Mailing Address - Fax:203-426-9253
Practice Address - Street 1:19 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1651
Practice Address - Country:US
Practice Address - Phone:203-426-1818
Practice Address - Fax:203-426-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03720Medicare PIN