1194770040 NPI number — PHYSICIANS HEALTH & WELLNESS CENTER, P.C.

Table of content: (NPI 1194770040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194770040 NPI number — PHYSICIANS HEALTH & WELLNESS CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS HEALTH & WELLNESS CENTER, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1194770040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 617
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAUGATUCK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06770-0617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-723-4032
Provider Business Mailing Address Fax Number:
203-723-4753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
778 NEW HAVEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAUGATUCK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06770-4782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-723-4032
Provider Business Practice Location Address Fax Number:
203-723-4753
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HODES
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SENIOR MANAGER
Authorized Official Telephone Number:
203-723-4032

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010037261CT01 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CU6385 . This is a "ACS HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7344083 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5274717 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1282180 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com