Provider Demographics
NPI:1912278961
Name:UNIVERSITY OF CONNECTICUT
Entity Type:Organization
Organization Name:UNIVERSITY OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:UMMERUBAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SYEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-967-5060
Mailing Address - Street 1:24 PARK PL
Mailing Address - Street 2:APT# 14K
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5008
Mailing Address - Country:US
Mailing Address - Phone:860-967-5060
Mailing Address - Fax:
Practice Address - Street 1:24 PARK PL
Practice Address - Street 2:APT# 14K
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5008
Practice Address - Country:US
Practice Address - Phone:860-967-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center