| Organization Name: | NORTHEAST SURGICAL CARE OF NEWINGTON, LLC |
| NPI Number: | 1043215858 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHILLIP CLENDENIN (PRESIDENT) |
| Mailing Address: | 2299 Woodbury Avenue Suite 5 Newington |
| State: | NH US |
| Postal Code: | 038017854 |
| Phone Number: | 6034315563 |
| Fax Number: | 6034312544 |
| NPI Enumeration Date: | 06/17/2005 |
| NPI Last Update Date: | 12/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 02754 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NH |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |