Provider Demographics
NPI:1730694316
Name:IMPACT HEALTH P.C.
Entity type:Organization
Organization Name:IMPACT HEALTH P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED PERSON
Authorized Official - Prefix:
Authorized Official - First Name:GARUMUNI
Authorized Official - Middle Name:A
Authorized Official - Last Name:DESILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-988-0766
Mailing Address - Street 1:14 WESTPORT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-3915
Mailing Address - Country:US
Mailing Address - Phone:000-000-0000
Mailing Address - Fax:
Practice Address - Street 1:14 WESTPORT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363L00000X, 101YM0800X, 103TB0200X, 103TC0700X, 103TC1900X, 207R00000X, 251J00000X, 363LA2200X, 363LF0000X, 363LG0600X, 363LP0808X
CT207R00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty