Healthcare Provider Details

I. General information

NPI: 1437702784
Provider Name (Legal Business Name): NEW ENGLAND HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 SOUTH AVE
NEW CANAAN CT
06840-5728
US

IV. Provider business mailing address

PO BOX 655
GUILFORD CT
06437-0655
US

V. Phone/Fax

Practice location:
  • Phone: 203-972-7766
  • Fax: 203-594-7282
Mailing address:
  • Phone: 203-972-7766
  • Fax: 203-594-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID DAYYA
Title or Position: OWNER
Credential: DO
Phone: 203-972-7766