Healthcare Provider Details

I. General information

NPI: 1750468963
Provider Name (Legal Business Name): CONNECTICUT NEUROLOGICAL SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LEWIS AVE SUITE 202
MERIDEN CT
06451-2121
US

IV. Provider business mailing address

455 LEWIS AVE STE 202
MERIDEN CT
06451-2121
US

V. Phone/Fax

Practice location:
  • Phone: 203-630-1000
  • Fax: 203-413-3333
Mailing address:
  • Phone: 203-630-1000
  • Fax: 203-413-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number042289
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number042289
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number042289
License Number StateCT

VIII. Authorized Official

Name: DR. HAMID SAMI
Title or Position: OWNER
Credential: MD
Phone: 203-630-1000