Healthcare Provider Details

I. General information

NPI: 1013270289
Provider Name (Legal Business Name): MY HEALTH 1ST URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 BRIDGEPORT AVE # J
MILFORD CT
06460-4167
US

IV. Provider business mailing address

470 BRIDGEPORT AVE # J
MILFORD CT
06460-4167
US

V. Phone/Fax

Practice location:
  • Phone: 203-693-3676
  • Fax: 203-876-9334
Mailing address:
  • Phone: 203-693-3676
  • Fax: 203-876-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number049851
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number049851
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. AWAIS MALIK
Title or Position: MEMBER
Credential: MD
Phone: 203-243-6018