1104959832 NPI number — DR. JOSEPH A DECESARE DPM

Table of content: DR. JOSEPH A DECESARE DPM (NPI 1104959832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104959832 NPI number — DR. JOSEPH A DECESARE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DECESARE
Provider First Name:
JOSEPH
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104959832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-3015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-421-9167
Provider Business Mailing Address Fax Number:
401-421-9193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-3015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-421-9167
Provider Business Practice Location Address Fax Number:
401-421-9193
Provider Enumeration Date:
03/13/2007

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: 213E00000X , with the licence number:  DPM00240 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0137515002 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2343 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2700150 . This is a "UNITED HEALTHCARE OF NEW" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 400515 . This is a "BLUECHIP OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000007071 . This is a "BLUE CROSS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 050456966 . This is a "WPS TRICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000007071 . This is a "BLUECHIP GROUP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 001868 . This is a "TUFTS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 050456966 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1006490001 . This is a "NHIC, CORP. DME MAC" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7001766 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: R003457 . This is a "WPS TRICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000000007071 . This is a "BLUE CROSS FEP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0005779230 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 050456966 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 782937 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: ZE5188 . This is a "BLUE CROSS OF MA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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