Provider Demographics
NPI:1831526458
Name:ANSONIA URGENT CARE LLC
Entity type:Organization
Organization Name:ANSONIA URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AWAIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-693-3676
Mailing Address - Street 1:158 MAIN ST
Mailing Address - Street 2:201
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1836
Mailing Address - Country:US
Mailing Address - Phone:203-693-3676
Mailing Address - Fax:
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:201
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1836
Practice Address - Country:US
Practice Address - Phone:203-693-3676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT049851302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization