Provider Demographics
NPI:1730209453
Name:FAMILY HEALTH CARE CENTER, LLC
Entity type:Organization
Organization Name:FAMILY HEALTH CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ISGUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-426-1818
Mailing Address - Street 1:19 CHURCH HILL RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1651
Mailing Address - Country:US
Mailing Address - Phone:203-426-1818
Mailing Address - Fax:203-426-9253
Practice Address - Street 1:19 CHURCH HILL RD
Practice Address - Street 2:SUITE #2
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1651
Practice Address - Country:US
Practice Address - Phone:203-426-1818
Practice Address - Fax:203-426-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036795207Q00000X
CT016010208000000X, 207Q00000X
CT002237363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03180OtherMEDICARE PTAN