1225074412 NPI number — DR. ELLISON BERNS M.D.

Table of content: DR. ELLISON BERNS M.D. (NPI 1225074412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225074412 NPI number — DR. ELLISON BERNS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNS
Provider First Name:
ELLISON
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1225074412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 ASYLUM AVE
Provider Second Line Business Mailing Address:
SUITE 3206
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-1770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-7977
Provider Business Mailing Address Fax Number:
860-714-9993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 ASYLUM AVE
Provider Second Line Business Practice Location Address:
SUITE 3206
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-1770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-7977
Provider Business Practice Location Address Fax Number:
860-714-9993
Provider Enumeration Date:
06/22/2006

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: 207RC0001X , with the licence number:  028734 , 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: 0210490004 . This is a "CIGNA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001287342 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010028734CT02 . This is a "BLUE CROSS & BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0V6122 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060058732 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 287340 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1217506 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HAS247 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2262193 . This is a "AETNA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".