4 Elements Direct Primary Care LLC
Internal Medicine in South Windsor, CT. Organization (NPI-2).
NPI number1730756636
StatusActive
Last updated in NPPESNov 1, 2025
Details
- NPI
- 1730756636
- Entity type
- Organization (NPI-2)
- Legal business name
- 4 Elements Direct Primary Care LLC
- Organization subpart
- No
- Enumeration date
- Jun 8, 2021
- Certification date
- Nov 1, 2025
- Last updated
- Nov 1, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
| 2083B0002X | Preventive Medicine, Obesity Medicine | – | – | |
| 208000000X | Pediatrics | – | – |
Practice location
1300 Sullivan AveSouth Windsor, CT 06074-2713
Phone 860-469-5646 · Fax 860-310-1122
Mailing address
1300 Sullivan AveSouth Windsor, CT 06074-2713
Phone 860-469-5646 · Fax 860-310-1122
Authorized official
Vasanth Kainkaryam
Managing Member
8604695656
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