1568529238 NPI number — MRS. SUSAN FERRIER LANG

Table of content: MRS. SUSAN FERRIER LANG (NPI 1568529238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568529238 NPI number — MRS. SUSAN FERRIER LANG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANG
Provider First Name:
SUSAN
Provider Middle Name:
FERRIER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERRIER
Provider Other First Name:
SUSAN
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568529238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD LYME
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06371-0172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-434-1190
Provider Business Mailing Address Fax Number:
860-434-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 HALLS RD
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
OLD LYME
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06371-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-434-1190
Provider Business Practice Location Address Fax Number:
860-434-1190
Provider Enumeration Date:
01/02/2007

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: 225100000X , with the licence number:  005063 , 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: 080005063CT05 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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