Provider Demographics
NPI:1619219243
Name:LATIF & MUSHTAQ LLC
Entity type:Organization
Organization Name:LATIF & MUSHTAQ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YASER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSHTAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-781-7123
Mailing Address - Street 1:585 BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3537
Mailing Address - Country:US
Mailing Address - Phone:860-781-7123
Mailing Address - Fax:860-781-7103
Practice Address - Street 1:585 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3537
Practice Address - Country:US
Practice Address - Phone:860-781-7123
Practice Address - Fax:860-781-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0066461041C0700X
CT0469182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty