EAST LYME PEDIATRIC CLINIC, LLC (NPI# 1326265745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326265745 |
| Entity Type | Organization |
| Organization Name | EAST LYME PEDIATRIC CLINIC, LLC |
| Other Organization Name | EAST LYME PEDIATRIC CLINIC |
| Practice Address |
170 Flanders Rd Niantic CT 06357-1208 |
| Practice Telephone | 8607397444 |
| Practice Fax Number | 8607393252 |
| Mailing Telephone | 8607397444 |
| Mailing Fax Number | 8607393252 |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2013-03-19 |
| Authorized Official Name | DR. SAJDA PERWEEN MALIK (MEMBER) |
| Authorized Official Telephone | 8607397444 |
| Authorized Official Credential | M.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
27074 | CT | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 001365263 | 05 |
| Other Name | Type Code |
|---|---|
| East Lyme Pediatric Clinic | Former Legal Business Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | EAST LYME PEDIATRIC CLINIC, LLC | 170 Flanders Rd., Niantic, CT 06357 |
| Street Address |
170 FLANDERS RD |
| City | NIANTIC |
| State | CT |
| Zip Code | 06357-1208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144314451 | Sajda Perween Malik | Pediatrics | 170 Flanders Rd, Niantic, CT 06357-1208 | 2006-10-03 |
| 1669514477 | David Mark Primo | Dentist | 170 Flanders Rd, Niantic, CT 06357-1208 | 2007-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093094401 | Pamela Dhillon | Nurse Practitioner | 215 West Main St, Niantic, CT 06357 | 2011-08-16 |
| 1841454485 | Richard Frederick Jones IIi | Obstetrics & Gynecology | 224 Old Balck Point Rd, Niantic, CT 06357 | 2008-07-14 |
| 1437224771 | Margaret C Barili | Registered Nurse | 369 Main Street, Niantic, CT 06357 | 2006-11-21 |
| 1720163942 | Carole C Olson | Psychologist | 4 N. Pine Street, Ninantic, CT 06357 | 2006-10-26 |
| 1427151513 | Melvin Harold Engel | Family Medicine | 50 Green Cliff Drive, Niantic, CT 06357 | 2006-09-06 |
| 1457304420 | Michele Nadine Litwin | Nurse Practitioner | 30 W Main Street, Niantic, CT 06357 | 2006-05-18 |
| 1487133906 | Ryne Mcmullen | Physical Therapist | 11 Freedom Way Unit B2, Niantic, CT 06357 | 2018-08-07 |
| 1558720854 | Bodhi Naturopathic LLC | Naturopath | 17 Hope Street, Nianic, CT 06357 | 2016-02-15 |
| 1477980480 | Heather Michelle Rynkowski | Physician Assistant | 365 Montauk Ave, Office # 3.525, New London, CT 06357 | 2013-10-04 |
| 1245662592 | Erica L Lussier | Nurse Practitioner | 248 Flanders Rd, Niantic, CT 06357 | 2013-08-08 |
| Find all providers in zip 06357 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134591696 | Southeastern Ct Primary Care, LLC | Clinic/Center | 10 Liberty Way Unit B10, Niantic, CT 06357-1033 | 2015-10-23 |
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|---|---|---|---|---|
| 1306447578 | Luca Health & Wellness, LLC | Clinic/Center | 2475 Albany Ave Ste 205, West Hartford, CT 06117-2523 | 2020-11-04 |
| 1699307751 | Pride Comprehensive Primary Care LLC | Clinic/Center | 7 Warren Rd, Wolcott, CT 06716-3015 | 2020-02-06 |
| 1316405186 | Ct Optimal Wellness, LLC | Clinic/Center | 115 Technology Dr Unit A103, Trumbull, CT 06611-6338 | 2019-03-11 |
| 1922586809 | Emmaus Health LLC | Clinic/Center | 945 Main St Ste 205, Manchester, CT 06040-6064 | 2018-08-01 |
| 1841781382 | Clifford W. Beers Guidance Clinic Inc | Clinic/Center | 41 Marne St, Hamden, CT 06514 | 2018-05-21 |
| 1598284622 | Np Wellness Care | Clinic/Center | 253 Fairlawn Dr, Torrington, CT 06790-5809 | 2017-09-09 |
| 1245773191 | Anchor Health Initiative Corp. | Clinic/Center | 30 Myano Ln Ste 16, Stamford, CT 06902-4532 | 2016-11-27 |
| 1588114870 | Whole Self Wellness, LLC | Clinic/Center | 144 Banjo Sullivan Rd, Griswold, CT 06351-1201 | 2016-10-11 |
| 1265892541 | Amanda M Swan Aprn LLC | Clinic/Center | 33 Harmund Pl, Wethersfield, CT 06109-1209 | 2016-03-01 |
| 1215321666 | Grand Medical LLC | Clinic/Center | 515 Higgins Rd, Cheshire, CT 06410-3326 | 2015-03-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.