Provider Demographics
NPI:1295868446
Name:INTERNAL MEDICINE OF CLINTON, LLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF CLINTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-669-3520
Mailing Address - Street 1:5 PEQUOT PARK ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2058
Mailing Address - Country:US
Mailing Address - Phone:860-399-6167
Mailing Address - Fax:
Practice Address - Street 1:8 E MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2058
Practice Address - Country:US
Practice Address - Phone:860-669-3520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031728261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02657Medicare ID - Type Unspecified