1679518047 NPI number — TODD A BELL DPM,LLC

Table of content: (NPI 1679518047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679518047 NPI number — TODD A BELL DPM,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TODD A BELL DPM,LLC
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:
1679518047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 JOLLEY DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06002-3062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-286-9161
Provider Business Mailing Address Fax Number:
860-242-1388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 JOLLEY DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06002-3062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-286-9161
Provider Business Practice Location Address Fax Number:
860-242-1388
Provider Enumeration Date:
06/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
TODD
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
860-286-9161

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  0472 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 0472 , 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: 004093762 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3857930001 . This is a "NSC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".