Provider Demographics
NPI:1952500092
Name:NEW HEALTH P A
Entity Type:Organization
Organization Name:NEW HEALTH P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:TARDY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-478-6506
Mailing Address - Street 1:40 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1810
Mailing Address - Country:US
Mailing Address - Phone:207-478-6506
Mailing Address - Fax:
Practice Address - Street 1:40 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1810
Practice Address - Country:US
Practice Address - Phone:207-478-6506
Practice Address - Fax:978-225-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1060174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048932OtherANTHEM
ME260240000Medicaid
3662706OtherCIGNA
1393159OtherAETNA