Provider Demographics
NPI:1265593990
Name:NEW CANAAN INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:NEW CANAAN INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:HASAPIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-972-4255
Mailing Address - Street 1:173 EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840
Mailing Address - Country:US
Mailing Address - Phone:203-972-4255
Mailing Address - Fax:203-972-6345
Practice Address - Street 1:173 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840
Practice Address - Country:US
Practice Address - Phone:203-972-4255
Practice Address - Fax:203-972-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002021666OtherUNITED HEALTH CARE
3387592OtherCIGNA
010038777CT02OtherANTHEM BC BS
7610180OtherAETNA
P2068445OtherOXFORD
CTC03036Medicare PIN