Provider Demographics
NPI:1982199212
Name:PALLIMD, PLLC
Entity Type:Organization
Organization Name:PALLIMD, PLLC
Other - Org Name:PALLIMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-770-9277
Mailing Address - Street 1:63 FIRE HILL RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-1005
Mailing Address - Country:US
Mailing Address - Phone:203-770-9277
Mailing Address - Fax:
Practice Address - Street 1:128 EAST AVE STE 2
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5741
Practice Address - Country:US
Practice Address - Phone:203-770-9277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040847207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001408477Medicaid