1386887263 NPI number — MR. JEFFREY B. NORDIN CRNA

Table of content: MR. JEFFREY B. NORDIN CRNA (NPI 1386887263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386887263 NPI number — MR. JEFFREY B. NORDIN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORDIN
Provider First Name:
JEFFREY
Provider Middle Name:
B.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1386887263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
YALE UNIVERSITY-ANESTHESIA
Provider Second Line Business Mailing Address:
333 CEDAR ST, TMP3
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06510-8051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-785-2802
Provider Business Mailing Address Fax Number:
203-785-6664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPARTMENT OF ANESTHESIA
Provider Second Line Business Practice Location Address:
20 YORK STREET
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06510-8051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-785-2802
Provider Business Practice Location Address Fax Number:
203-785-6664
Provider Enumeration Date:
04/08/2009

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: 163W00000X , with the licence number:  551730 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 3783 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 004706 , 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: PENDING , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".