1013054352 NPI number — MRS. SUSAN DEMELIS TUROTSY PAC

Table of content: MRS. SUSAN DEMELIS TUROTSY PAC (NPI 1013054352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013054352 NPI number — MRS. SUSAN DEMELIS TUROTSY PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUROTSY
Provider First Name:
SUSAN
Provider Middle Name:
DEMELIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEMELIS
Provider Other First Name:
SUSAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013054352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1563 POST RD EAST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-319-3939
Provider Business Mailing Address Fax Number:
203-319-3966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1563 POST RD EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-319-3939
Provider Business Practice Location Address Fax Number:
203-319-3966
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  000427 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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