1215132402 NPI number — MAX CHOROWSKI M.D.

Table of content: MAX CHOROWSKI M.D. (NPI 1215132402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215132402 NPI number — MAX CHOROWSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOROWSKI
Provider First Name:
MAX
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1215132402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 DWIGHT RD STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01106-1748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-374-9287
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 DWIGHT RD STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGMEADOW
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01106-1748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-374-9287
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2007

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: 207VG0400X , with the licence number:  46072 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 46072 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0114774 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0452662003 . This is a "CIGNA PAL ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7U210 . This is a "EMPIRE BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: N51732 . This is a "BCBS GYN IND." identifier . This identifiers is of the category "OTHER".
  • Identifier: 130408 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17846 . This is a "LICENSE #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 789175 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9757139 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29397 . This is a "CHILDREN'S MEDICAL SECURI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7906443 . This is a "AETNA US HC PSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0459212 . This is a "AETNA US HC IND." identifier . This identifiers is of the category "OTHER".
  • Identifier: 2082565 . This is a "AETNA US HC GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4210483 . This is a "AETNA US GYN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46072 . This is a "LISC # MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M17234 . This is a "BCBS PSYCHIATRY CORP" identifier . This identifiers is of the category "OTHER".
  • Identifier: M14857 . This is a "BCBS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: V03951 . This is a "BCBS PSYCH IND." identifier . This identifiers is of the category "OTHER".




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