Organization
EAST LYME PEDIATRIC CLINIC, LLC
Active
Other names
East Lyme Pediatric Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAJDA PERWEEN MALIK M.D (MEMBER)
(860) 739-7444
Entity
Organization
Contact information
Practice address
170 FLANDERS RD, NIANTIC, CT 06357-1208
(860) 739-7444
(860) 739-3252
Mailing address
170 FLANDERS RD, NIANTIC, CT 06357-1208
(860) 739-7444
(860) 739-3252
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
27074
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001365263
—
CT
Enumeration date
04/19/2007
Last updated
03/19/2013
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