Healthcare Provider Details

I. General information

NPI: 1740528967
Provider Name (Legal Business Name): FAROOQ DADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 SILAS DEANE HWY
ROCKY HILL CT
06067-2329
US

IV. Provider business mailing address

18 TRUMBULL LN
WEST HARTFORD CT
06117-2756
US

V. Phone/Fax

Practice location:
  • Phone: 860-523-9426
  • Fax:
Mailing address:
  • Phone: 860-523-9426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number040063
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number040063
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040063
License Number StateCT

VIII. Authorized Official

Name: DR. MOHAMMAD FAROOQ DADA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 860-523-9426