Healthcare Provider Details

I. General information

NPI: 1306211008
Provider Name (Legal Business Name): CONTINUUM MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 UNIVERSAL DR N
NORTH HAVEN CT
06473-3152
US

IV. Provider business mailing address

163 UNIVERSAL DR N
NORTH HAVEN CT
06473-3152
US

V. Phone/Fax

Practice location:
  • Phone: 203-466-8060
  • Fax: 203-907-3279
Mailing address:
  • Phone: 203-466-8060
  • Fax: 203-907-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JASDEEP SIDANA
Title or Position: OWNER
Credential: MD
Phone: 203-466-8060