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General NPI Number Information
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NPI Number | 1356403323
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Entity Type | Organization
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Legal Business Name | NEW MILFORD MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 11 OLD PARK LANE RD
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City | NEW MILFORD
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State | CT
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Zip | 06776-2507
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Country | US
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Telephone | 860-355-1149
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Fax | 860-355-5957
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Provider Business Mailing Address
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Address Line | 11 OLD PARK LANE RD
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City | NEW MILFORD
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State | CT
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Zip | 06776-2507
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Country | US
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Telephone | 860-355-1149
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Fax | 860-355-5957
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MARIA MARTINEZ
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Credential | CPC, CPCS
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Telephone | 860-350-7685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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