Provider Demographics
NPI:1881639094
Name:R.R.K.LLC
Entity type:Organization
Organization Name:R.R.K.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:RANADE
Authorized Official - Last Name:KAPUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-721-7911
Mailing Address - Street 1:530 SILAS DEANE HWY
Mailing Address - Street 2:SUITE NUMBER 340
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2234
Mailing Address - Country:US
Mailing Address - Phone:860-721-7911
Mailing Address - Fax:860-257-0272
Practice Address - Street 1:530 SILAS DEANE HWY
Practice Address - Street 2:SUITE NUMBER 340
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2234
Practice Address - Country:US
Practice Address - Phone:860-721-7911
Practice Address - Fax:860-257-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20514261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1205146Medicaid
CTD02652Medicare UPIN