=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528483807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHEASTERN PULMONARY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2014
-----------------------------------------------------
Last Update Date | 02/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27 NAEK RD SUITE 2
-----------------------------------------------------
City | VERNON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06066-3965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-875-2444
-----------------------------------------------------
Fax | 860-875-1952
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 NAEK RD SUITE 2
-----------------------------------------------------
City | VERNON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06066-3965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-875-2444
-----------------------------------------------------
Fax | 860-875-1952
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. MOHAMMAD SAUD ANWAR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 860-875-2444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5638
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------