Provider Demographics
NPI:1457118721
Name:NORTHEAST PREMIER PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:NORTHEAST PREMIER PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN DC
Authorized Official - Phone:860-232-1576
Mailing Address - Street 1:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06083-1153
Mailing Address - Country:US
Mailing Address - Phone:860-232-1576
Mailing Address - Fax:860-432-8669
Practice Address - Street 1:151 NEW PARK AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2191
Practice Address - Country:US
Practice Address - Phone:860-232-1576
Practice Address - Fax:860-432-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty