Organization
FAROOQ DADA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD FAROOQ DADA M.D. (PHYSICIAN)
(860) 523-9426
Entity
Organization
Contact information
Practice address
2275 SILAS DEANE HWY, ROCKY HILL, CT 06067-2329
(860) 523-9426
Mailing address
18 TRUMBULL LN, WEST HARTFORD, CT 06117-2756
(860) 523-9426
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
040063
CT
283Q00000X
Psychiatric Hospital
040063
CT
314000000X
Skilled Nursing Facility
040063
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001400639
—
CT
Enumeration date
01/23/2013
Last updated
08/12/2015
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