Healthcare Provider Details

I. General information

NPI: 1376944678
Provider Name (Legal Business Name): NORTHEAST NATURAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2014
Last Update Date: 09/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CHURCH HILL RD SUITE 1
NEWTOWN CT
06470-1651
US

IV. Provider business mailing address

19 CHURCH HILL RD SUITE 1
NEWTOWN CT
06470-1651
US

V. Phone/Fax

Practice location:
  • Phone: 800-723-2962
  • Fax:
Mailing address:
  • Phone: 800-723-2962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000425
License Number StateCT

VIII. Authorized Official

Name: DR. SHAWN M. CARNEY
Title or Position: OWNER
Credential: N.D.
Phone: 800-723-2962