Healthcare Provider Details

I. General information

NPI: 1194165720
Provider Name (Legal Business Name): H AND B QUALITY MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 IVY BROOK RD STE 120
SHELTON CT
06484-6416
US

IV. Provider business mailing address

2 IVY BROOK RD STE 120
SHELTON CT
06484-6416
US

V. Phone/Fax

Practice location:
  • Phone: 860-754-7407
  • Fax:
Mailing address:
  • Phone: 860-754-7407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number046285
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number46181
License Number StateCT

VIII. Authorized Official

Name: DR. NAMI BAYAN
Title or Position: INTERNIST /DIRECTOR
Credential: MD
Phone: 860-754-7407