Unknown Individual – Psychiatry Physician, NPI 1164527404

Unknown Individual is a healthcare provider. based in New london, Connecticut. specializing in Psychiatry Physician. They hold a License No. 015247 (CT). The NPI Number for Unknown Individual is 1164527404

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1164527404
Phone
(860) 443-1200
Address
292 MONTAUK AVENUE
Deactivation Date
27 February 2025
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 292, Montauk Avenue, Montauk Avenue Historic District, Downtown New London, New London, Southeastern Connecticut Planning Region, Connecticut, 06320, United States

    NEW LONDON, CT 06320

    Phone: (860) 443-1200

    Fax: (860) 442-4488

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 06320)

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Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1164527404 on file in the registry.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with New London?
Public fields place Unknown Individual around New London, Connecticut. Always confirm the exact site before visiting.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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