Basic Information
| Provider Information | |||||||||
| NPI: | 1437296415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED FAMILY PHYSICIANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 146 DANBURY RD | ||||||||
| Address2: | |||||||||
| City: | NEW MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067763427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603504000 | ||||||||
| FaxNumber: | 8603555581 | ||||||||
| Practice Location | |||||||||
| Address1: | 146 DANBURY RD | ||||||||
| Address2: | |||||||||
| City: | NEW MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067763427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603504000 | ||||||||
| FaxNumber: | 8603555581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 8603504000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 004104741 | 05 | CT | MEDICAID | C01279 | 01 | CT | PTAN | OTHER | 001289786 | 05 | CT | MEDICAID | 001290858 | 05 | CT | MEDICAID |