Healthcare Provider Details

I. General information

NPI: 1518051002
Provider Name (Legal Business Name): ORANGE INTERNAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 INDIAN RIVER RD SUITE C2
ORANGE CT
06477-3649
US

IV. Provider business mailing address

PO BOX 762
ORANGE CT
06477-0762
US

V. Phone/Fax

Practice location:
  • Phone: 203-795-3617
  • Fax: 203-795-3618
Mailing address:
  • Phone: 203-795-3617
  • Fax: 203-795-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. AZIM SALIM FAHMI
Title or Position: DIRECTOR OF OPERATIONS
Credential: MBA
Phone: 203-795-3617