| Organization Name: | EAST LYME PEDIATRIC CLINIC, LLC |
| NPI Number: | 1326265745 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SAJDA PERWEEN MALIK (MEMBER) |
| Mailing Address: | 170 Flanders Rd Niantic |
| State: | CT US |
| Postal Code: | 063571208 |
| Phone Number: | 8607397444 |
| Fax Number: | 8607393252 |
| NPI Enumeration Date: | 04/19/2007 |
| NPI Last Update Date: | 03/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 27074 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |