# SOUTHEASTERN PULMONARY ASSOC. PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295754273
- **Authorized official:** MR. JOHN S URBANETTI MD (CEO)
- **Authorized official phone:** (860) 444-2223

## Contact information

- **Practice address:** 155 MONTAUK AVENUE, NEW LONDON, CT 06320
- **Practice address phone:** (860) 444-2223
- **Practice address fax:** (860) 440-3153
- **Mailing address:** 155 MONTAUK AVENUE, NEW LONDON, CT 06320
- **Mailing address phone:** (860) 444-2223
- **Mailing address fax:** (860) 440-3153

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RP1001X | Pulmonary Disease Physician | 022011 | CT | Yes |
| 207RP1001X | Pulmonary Disease Physician | 022057 | CT | — |

## Other

- **Enumeration date:** 07/19/2006
- **Last updated:** 01/20/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 022057 | LIC DR ROBERT KELTNER | CT |
| 05 | — | 1220110 | — | CT |
| 05 | — | 1220573 | — | CT |