Healthcare Provider Details

I. General information

NPI: 1346408796
Provider Name (Legal Business Name): PARADIGM MEDICAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2008
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MILL PLAIN RD
FAIRFIELD CT
06824-5048
US

IV. Provider business mailing address

575 WINNEPOGE DR
FAIRFIELD CT
06825-2562
US

V. Phone/Fax

Practice location:
  • Phone: 203-763-9452
  • Fax:
Mailing address:
  • Phone: 203-763-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number003040
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number01334712
License Number StateNJ

VIII. Authorized Official

Name: MRS. ELIZABETH TAN KAMLANI
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 203-763-9452