Priority Family Healthcare of Northeast Connecticut, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

038188 Issued in CT

Legal business name

PRIORITY FAMILY HEALTHCARE OF NORTHEAST CONNECTICUT, LLC

Practice address

353 Pomfret St
Putnam, CT 06260-1835

Phone

(860) 928-1111

NPI assigned

Jul 23, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Raja Fattaleh, MDNPI 1841283439

Title

Owner

Phone

(860) 928-1111

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raja Fattaleh, MD

  • Family Medicine Physician
  • Putnam, CT
  • NPI 1841283439
  Medicare reassignment NPD Authorized official
• Sara E Garcia-Gomes, APRN

  • Family Nurse Practitioner
  • Putnam, CT
  • NPI 1467061655
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421280000000",
    "number": "1720391311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 333",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062600333",
            "telephone_number": "860-928-1111",
            "fax_number": "860-963-7756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 POMFRET ST",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062601835",
            "telephone_number": "860-928-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIORITY FAMILY HEALTHCARE OF NORTHEAST CONNECTICUT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-23",
        "last_updated": "2015-01-15",
        "status": "A",
        "authorized_official_last_name": "FATTALEH",
        "authorized_official_first_name": "RAJA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-928-1111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "038188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001381889",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Pontarelli
• Positive Mind Counseling
• Justine Poudrette
• Preservation Within Therapy Practice, LLC
• Price Chopper Inc (Price Chopper Pharmacy)
• Psych Associates New England
• Putnam Board of Education
• Putnam Cardiology Associates, P.C.
• Putnam EMS Ambulance Service Inc
• Putnam Family Dental

• Family Medicine Physician in Putnam, CT
• Providers in Putnam, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.