Provider Demographics
NPI:1780958884
Name:DISABILITY DETERMINATION SERVICES
Entity type:Organization
Organization Name:DISABILITY DETERMINATION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-466-6302
Mailing Address - Street 1:20 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1016
Mailing Address - Country:US
Mailing Address - Phone:860-223-4694
Mailing Address - Fax:
Practice Address - Street 1:309 WAWARME AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1509
Practice Address - Country:US
Practice Address - Phone:860-466-6302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT012934261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care