Provider Demographics
NPI:1740528967
Name:FAROOQ DADA LLC
Entity type:Organization
Organization Name:FAROOQ DADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:FAROOQ
Authorized Official - Last Name:DADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-523-9426
Mailing Address - Street 1:18 TRUMBULL LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2756
Mailing Address - Country:US
Mailing Address - Phone:860-523-9426
Mailing Address - Fax:
Practice Address - Street 1:2275 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2329
Practice Address - Country:US
Practice Address - Phone:860-523-9426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040063261QM0801X, 283Q00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No283Q00000XHospitalsPsychiatric Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001400639Medicaid
CT001400639Medicaid
CT100881Medicare UPIN