Provider Demographics
NPI:1740653278
Name:NEW ENGLAND PA LLC
Entity type:Organization
Organization Name:NEW ENGLAND PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:PATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-390-6000
Mailing Address - Street 1:5 DAVIS ROAD EAST
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371
Mailing Address - Country:US
Mailing Address - Phone:860-390-6000
Mailing Address - Fax:860-215-8150
Practice Address - Street 1:5 DAVIS ROAD EAST
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371
Practice Address - Country:US
Practice Address - Phone:860-390-6000
Practice Address - Fax:860-215-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001845363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty