=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770714453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW ENGLAND PSYCHIATRIC ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2009
-----------------------------------------------------
Last Update Date | 07/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 HOSPITAL HILL RD
-----------------------------------------------------
City | SHARON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06069-2096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-364-4288
-----------------------------------------------------
Fax | 860-364-4268
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 S MAIN ST UNIT 4
-----------------------------------------------------
City | CHESHIRE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06410-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-439-9155
-----------------------------------------------------
Fax | 203-439-9156
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. SABOOH MUBBASHAR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 203-439-9155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------