Healthcare Provider Details

I. General information

NPI: 1699064113
Provider Name (Legal Business Name): LUNG DOCS OF CT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 BOSTON POST ROAD
ORANGE CT
06477
US

IV. Provider business mailing address

163 UNIVERSAL DR N
NORTH HAVEN CT
06473-3152
US

V. Phone/Fax

Practice location:
  • Phone: 203-523-0971
  • Fax: 203-529-3273
Mailing address:
  • Phone: 203-466-8060
  • Fax: 203-907-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JASDEEP SIDANA
Title or Position: OWNER
Credential: MD
Phone: 203-523-0971